Background Biological therapies have allowed better control of disease activity in patients with Rheumatoid Arthritis and Psoriatic Arthritis; however, its high cost may be a limitation to widespread use. Therefore, it seems reasonable to make an optimization strategy in dose of such drugs in patients with remission or low activity disease meanwhile therapeutic target remains stable.
Objectives 1. To analyze the clinical outcome assessed by DAS28 in Rheumatoid Arthritis (RA) and Polyarticular Psoriatic Arthritis (PPsA) patients in biological treatment followed by second-level Hospital Rheumatology Unit who were undergoing therapeutic optimization. 2. To analyze the optimization strategies used with different biological drugs.
Methods An observational, longitudinal, retrospective and descriptive study by reviewing medical records (from January 2013 to January 2014) of patients with RA and PPsA on biological therapies, with at least 6 months remission (DAS28 <2.6) or minimal clinical activity (DAS28 2.6-3.2), who were optimized. Demographic data, duration of the disease before the use of biological drug, time of biologic in optimization dose, clinical evaluation pre and post-optimization by DAS28 (at 3, 6 and 12 months) and therapeutic strategy are discussed. Statistical analysis was performed using IBM SPSS version 20.0 program.
Results Two hundred seventy-nine patients with RA and PPsA were on biological treatment, fifty-seven (57/20.43%) were undergoing therapeutic optimization. Thirty-seven (37/64.9%) RA and twenty (20/35.1%) PPsA. Thirty-six (36/63.2%) were women and twenty-one (21/36.8%) men. Mean age was 54±13 years. The mean duration of disease prior to the beginning of biologic treatment was 7.2±5.7 years. The mean time with biologic treatment standard dose was 63.7±31 months; the average time on optimized doses was 13.3±9.9 months. After optimization, fifty (50/87.7%) patients were in DAS28 remission and seven (7/12.3%) in low DAS28 activity. At the end of the study (6 months after optimization), forty-eight (48/84,2%) continued to be in clinical remission, three (3/5.3%) in low activity, four (4/7%) in moderate activity and two (2/3.5%) in high DAS28 activity. In patients with RA, five (5/8.7%) (four with adalimumab 40 mg every 21 days and one with etanercept 25 mg weekly) needed start over the standard dose of the drug, remaining in optimized dose thirty-two (32/56.1%) of RA patients of the study. In PPsA patients, one (1/1.8%) patient (etanercept 50 mg sc every 10 days) had worse (DAS28 4.65), so he returned to the standard dose. Optimization strategies were: adalimumab 40 mg every 21 days (24/42,1%), etanercept 25 mg every week (21/36,8%), etanercept 50 mg every 10 days (3/5,3%) or every 15 days (5/8,8%), certolizumab pegol 200 mg every 4 weeks (1/1, 8%), abatacept 500 mg every 6 weeks (1/1,8%) and infliximab 3 mg/kg every 10 weeks (2/3,5%).
Conclusions In our experience, a high number of patients with RA or PPsA in remission or low disease activity after standard biological treatment, remain in remission or low clinical activity after optimizing biological therapy. The most common optimization strategies used were etanercept 25 mg sc weekly and adalimumab 40 mg sc every 21 days.
Disclosure of Interest : None declared
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