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Dose down-titration of biological DMARDs in patients with rheumatoid arthritis over time and in daily clinical practice
L. Rodriguez-Rodriguez1, L. Leon2, J.R. Lamas3, A. Gomez4, C. Vadillo5, M. Blanco6, J.A. Jover7, L. Abasolo8
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IDISSC), Hospital Clínico San Carlos, Madrid, Spain.
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IDISSC), Hospital Clínico San Carlos, Madrid; and Universidad Camilo José Cela, Madrid, Spain. lleon.hcsc@salud.madrid.org
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IDISSC), Hospital Clínico San Carlos, Madrid, Spain.
- Rheumatology Unit, Hospital Clínico San Carlos, Madrid, Spain.
- Rheumatology Unit, Hospital Clínico San Carlos, Madrid, Spain.
- Rheumatology Unit, Hospital Clínico San Carlos, Madrid, Spain.
- Rheumatology Unit, Hospital Clínico San Carlos, Madrid; and Medicine Department, Universidad Complutense, Madrid, Spain.
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IDISSC), Hospital Clínico San Carlos, Madrid, Spain.
CER9101
2016 Vol.34, N°5
PI 0872, PF 0879
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PMID: 27214094 [PubMed]
Received: 04/11/2015
Accepted : 15/02/2016
In Press: 19/05/2016
Published: 16/09/2016
Abstract
OBJECTIVES:
To describe and compare dosing optimisation in biological DMARDs (bDMARDs) and relapses after that, in a cohort of rheumatoid arthritis (RA) during clinical practice.
METHODS:
Observational retrospective longitudinal study of RA patients taking bDMARDs from December 1999 to November 2013. Optimisation was defined as a 15% decrease in dose either reducing single dose or separating dose interval administration, for at least 4 times the recommended period between dosages. Relapse was defined as suspension or starting again with the recommended dose after optimisation. Incidence rates (IR) per 100 patient-years were estimated using survival techniques. Cox multivariate models were conducted to compare bDMARDs expressed in hazard ratios (HR) and confidence intervals [95%CI].
RESULTS:
443 patients and 752 different courses of bDMARDs treatments were included. We observed 146 optimisations with an IR of 8.1. The HR of optimisation in: a) adalimumab, etanercept and rituximab compared to infliximab was 1.56 [1.01-2.4], 1.5 [0.9-2.4] and 0.6 [0.3-1.4], respectively; b) adalimumab, etanercept compared to rituximab were 2.3 [1.2-4.5] and 2.2 [1.2-4.3]. There were no statistically significant differences between adalimumab and etanercept. Following optimisation, 36% relapsed (78% due to disease activity). The IR related to disease activity was 6.3, and was lower for adalimumab and etanercept compared to infliximab (HR: 0.42; [0.19-0.94]; HR: 0.34; [0.13-0.89], respectively). There were no statistically significant differences between etanercept and adalimumab. No patients on rituximab relapsed.
CONCLUSIONS:
Optimisation was similar between adalimumab and etanercept, and was lower for infliximab and rituximab. After optimisation, rituximab did not relapse, but infliximab did with the highest hazard.