Biological Dose Tapering in Daily Clinical Practice: A 10 Year Follow-up Study

• Published in: Reumatologia clinica Vol. 16; no. 5; pp. 319 - 323
• Main Authors: Alperi-López, Mercedes, Alonso-Castro, Sara, Morante-Bolado, Isla, Queiro-Silva, Rubén, Riestra-Noriega, José Luis, Arboleya, Luis, Ballina-García, Francisco Javier
• Format: Journal Article
• Language: English; Spanish
• Published: Spain Elsevier España, S.L.U 01.09.2020
• Subjects: Adalimumab; Ajuste de dosis; Artritis reumatoide; Clinical practice; Dose down-titration; Dose optimization; Etanercept; Infliximab; Optimización de la dosis; Práctica clínica; Rheumatoid arthritis; Rheumatology; Rituximab; Tocilizumab; Tocilizumab; Ajuste de dosis; Rituximab; Optimización de la dosis; Práctica clínica; Clinical practice; Artritis reumatoide; Infliximab; Etanercept; Rheumatoid arthritis; Dose optimization; Adalimumab; Dose down-titration
• ISSN: 1699-258X; 1885-1398; 2173-5743
• DOI: 10.1016/j.reuma.2018.08.002

Abstract Objective To describe practice patterns, long-term outcome, and related factors, in relation to biological therapies tapering in rheumatoid arthritis (RA) patients in a well-controlled real-world setting. Methods An observational longitudinal retrospective 10-year study was conducted in all RA patients receiving biological agents in an RA clinic from May 2003 to October 2013. Biological treatment of patients with sustained DAS28 < 3.2 or SDAI < 11 was tapered (dose down-titrated or interval widen) or discontinued as per practice protocol. Primary outcome of tapering was relapse, defined as an increase in DAS28 ≥ 1.2. Descriptive, survival analysis, and logistic regression analysis with first relapse as dependent variable were carried out. Results Of 193 RA patients on biological treatment (mean age 54 ± 14 years, 81% women), tapering was applied in 106 (55%) and discontinuation in 34 (17.6%). During follow-up 38 patients relapsed (62%). Rate of relapse was 10% at 6 months, 19% at 12 months, 33.2% at 2 years and 50% after 5 years. Mean time in dose reduction was 4.5 years [95% confidence interval (95% CI): 3.7–5.3]. Six patients (15.7%) did not respond after reinstatement of full dose of biologic. In the multivariate analysis, pain [OR = 1.26 (95% CI: 1.11–1.43); P < .001] and erythrocyte sedimentation rate (ESR) [OR = 1.01 (95% CI: 1.00–1.03); P = .011] at baseline were associated with relapse after tapering. Conclusions Tapering may be considered a long-term option in RA patients on biologics and low disease activity, especially if low ESR and pain scores are present at baseline; treatment reinstatement could be considered a safe option in case of relapse.