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Extended report
Down-titration and discontinuation of infliximab in rheumatoid arthritis patients with stable low disease activity and stable treatment: an observational cohort study
  1. Aatke van der Maas1,
  2. Wietske Kievit2,
  3. Bart J F van den Bemt3,
  4. Frank H J van den Hoogen1,
  5. Piet L van Riel4,
  6. Alfons A den Broeder1
  1. 1Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands
  2. 2Department of Rheumatology, Radboud University, Nijmegen Medical Centre, Nijmegen, The Netherlands
  3. 3Department of Pharmacy, Sint Maartenskliniek, Nijmegen, The Netherlands
  4. 4Department of Rheumatology, Radboud University, Nijmegen Medical Center, Nijmegen, The Netherlands
  1. Correspondence to Aatke van der Maas, Sint Maartenskliniek, Rheumatology, Hengstdal 3, Postbus 9011, Nijmegen 6500 GM, The Netherlands; a.vandermaas{at}


Down-titration, or discontinuing infliximab, has proven to be feasible in RA patients. Therefore, our local treatment protocol includes tapering infliximab dose. This observational study describes the prevalence of successful down-titration in daily clinical practice and its effect on costs and quality of life (QoL).

Methods Infliximab was down-titrated with 25% of the original dose (3 mg/kg) every 8–12 weeks without interval change until discontinuation or flare in all RA patients with stable low 28-joint disease activity score (DAS28) and stable treatment for >6 months. During 1 year DAS28, RA medication, outpatient clinic visits, RA related absenteeism and EuroQoL5D (European QoL questionnaire, EQ5D) were documented. Prevalence of successful down-titration and changes in DAS28, QoL and costs were described.

Results In 16% (95% CI 6 to 26) and 45% (95% CI 31 to 59), respectively, infliximab could be discontinued or down-titrated. Mean infliximab dose decreased significantly from 224 mg (95% CI 212 to 236 mg) at start, to 130 mg (95% CI 105 to 154 mg) after 1 year. Median DAS28 increased from 2.5 (p25–75=2.0–2.9) to 2.8 (2.2–3.6) (p=0.002). Extra corticosteroids were given in 8% of the visits. Disease modifying antirheumatic drugs were seldom changed. There was no statistical difference in QoL after down-titration. Mean reduction in the costs was €3474 (95% CI 2457 to 4492) per patient.

Conclusion In the majority of patients with stable low DAS28 and stable treatment, infliximab can be down-titrated or discontinued, which results in a considerable reduction in costs without influencing QoL.

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  • Competing interests Piet van Riel has received grants from Merck, Pfizer, Abbott, BMS, Roche. The other authors have no competing interests to report.

  • Patient Consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.