Der-Yuan Chen1,2, Chak Sing Lau3, Bassel Elzorkany4, Ping-Ning Hsu5, Sonja Praprotnik6, Radu Vasilescu7, Lisa Marshall8, Lyndon Llamado9. 1. Division of Allergy, Immunology and Rheumatology, Department of Medical Education and Research, Taichung Veterans General Hospital, Taichung, Taiwan. 2. Institute of Biomedical Science and Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan. 3. Division of Rheumatology and Clinical Immunology, The University of Hong Kong, Pokfulam, Hong Kong. 4. Department of Rheumatology, Cairo University, Cairo, Egypt. 5. National Taiwan University, Taipei, Taiwan. 6. University Medical Center, Ljubljana, Slovenia. 7. Regional Medical Affairs, Pfizer, Brussels, Belgium. 8. Global Medical Affairs, Pfizer, Collegeville, Pennsylvania, USA. 9. Medical and Regulatory Affairs, Pfizer, Inc., Makati City, Philippines.
Abstract
AIM: To review the published studies that dose down and then discontinue biologic therapy in patients with rheumatoid arthritis (RA), particularly concerning the criteria for such dosing and the impact on clinical outcomes. METHODS: Published studies conducted in patients with RA that sequentially decreased the dose and then discontinued therapy were included if one or more of the following biologic disease modifying antirheumatic drugs (bDMARDs) was evaluated: abatacept, adalimumab, certolizumab, etanercept, golimumab, infliximab, rituximab or tocilizumab. RESULTS: Five studies qualified for inclusion. The populations of patients with RA were heterogeneous among the studies; patients were required to have low disease activity (LDA) or to be in remission prior to dose titration. Approximately 25-65% of patients successfully decreased and in some cases, discontinued the bDMARD. However, the flare rate was higher than for the patients who remained on a standard dose. The only variable that predicted relapse in more than one study was down-titration of the bDMARD dose. CONCLUSION: In patients who have achieved LDA or remission, down-titration and discontinuation of bDMARD therapy may be attempted, with careful monitoring. However, it is likely that some patients will flare, and it is not known how to predict these patients.
AIM: To review the published studies that dose down and then discontinue biologic therapy in patients with rheumatoid arthritis (RA), particularly concerning the criteria for such dosing and the impact on clinical outcomes. METHODS: Published studies conducted in patients with RA that sequentially decreased the dose and then discontinued therapy were included if one or more of the following biologic disease modifying antirheumatic drugs (bDMARDs) was evaluated: abatacept, adalimumab, certolizumab, etanercept, golimumab, infliximab, rituximab or tocilizumab. RESULTS: Five studies qualified for inclusion. The populations of patients with RA were heterogeneous among the studies; patients were required to have low disease activity (LDA) or to be in remission prior to dose titration. Approximately 25-65% of patients successfully decreased and in some cases, discontinued the bDMARD. However, the flare rate was higher than for the patients who remained on a standard dose. The only variable that predicted relapse in more than one study was down-titration of the bDMARD dose. CONCLUSION: In patients who have achieved LDA or remission, down-titration and discontinuation of bDMARD therapy may be attempted, with careful monitoring. However, it is likely that some patients will flare, and it is not known how to predict these patients.
Authors: Yoshiya Tanaka; Josef S Smolen; Heather Jones; Annette Szumski; Lisa Marshall; Paul Emery Journal: Arthritis Res Ther Date: 2019-07-05 Impact factor: 5.156