Rheumatology International

, Volume 34, Issue 8, pp 1059–1063 | Cite as

Observational study of optimization of biologic therapies in rheumatoid arthritis: a single-centre experience

  • Jose Ramon Maneiro
  • Eva Perez-Pampin
  • Eva Salgado
  • Loreto Carmona
  • Juan J. Gomez-Reino
Short Communication

Abstract

To analyse the effectiveness of optimization of biologics in rheumatoid arthritis (RA). It was a single-centre retrospective observational study from January 2009 to September 2012. The effectiveness of the optimization of TNF antagonists, tocilizumab and abatacept in RA was studied. Optimization included predefined dose down-titration and/or expansion of dose interval in early arthritis with sustained DAS28-ESR <2.6 and established arthritis with a sustained DAS28-ESR <3.2. Primary outcome was time to relapse defined as increase in DAS28-ESR greater than 20 % over baseline. Cox’s regression analysis was performed to identify predictors of relapse. Sixty-four patients were included in the study. In the survival analysis, rates of relapse were 9.8 % at 6 months, 31.4 % at 12 months and 44.6 % at 18 months. Rates of patients with an increase in DAS28-ESR > 20 % and ≥1 inflamed joint at 6, 9 and 18 months were 1.6, 17.2 and 27.1 %, respectively. In relapsing patients, mean DAS28-ESR at relapse was 3.44 (2.94–4.79) and mean DAS28-ESR following the return to the prior dose of the biologic was 2.52 (1.42–3.21). No predictors of relapse were found in multivariate analysis. Optimization of the treatment with biologics in RA is an efficacious and safe treatment option.

Keywords

Rheumatoid arthritis Optimization TNF antagonists Abatacept Tocilizumab 

References

  1. 1.
    Hetland ML, Christensen IJ, Tarp U, Dreyer L, Hansen A, Hansen IT, Kollerup G, Linde L, Lindegaard HM, Poulsen UE, Schlemmer A, Jensen DV, Jensen S, Hostenkamp G, Ostergaard M (2010) Direct comparison of treatment responses, remission rates, and drug adherence in patients with rheumatoid arthritis treated with adalimumab, etanercept, or infliximab: results from eight years of surveillance of clinical practice in the nationwide Danish DANBIO registry. Arthritis Rheum 62(1):22–32. doi:10.1002/art.27227 PubMedCrossRefGoogle Scholar
  2. 2.
    Leffers HC, Ostergaard M, Glintborg B, Krogh NS, Foged H, Tarp U, Lorenzen T, Hansen A, Hansen MS, Jacobsen MS, Dreyer L, Hetland ML (2011) Efficacy of abatacept and tocilizumab in patients with rheumatoid arthritis treated in clinical practice: results from the nationwide Danish DANBIO registry. Ann Rheum Dis 70(7):1216–1222. doi:10.1136/ard.2010.140129 PubMedCrossRefGoogle Scholar
  3. 3.
    Nam JL, Winthrop KL, van Vollenhoven RF, Pavelka K, Valesini G, Hensor EM, Worthy G, Landewe R, Smolen JS, Emery P, Buch MH (2010) Current evidence for the management of rheumatoid arthritis with biological disease-modifying antirheumatic drugs: a systematic literature review informing the EULAR recommendations for the management of RA. Ann Rheum Dis 69(6):976–986. doi:10.1136/ard.2009.126573 PubMedCrossRefGoogle Scholar
  4. 4.
    Brocq O, Millasseau E, Albert C, Grisot C, Flory P, Roux CH, Euller-Ziegler L (2009) Effect of discontinuing TNFalpha antagonist therapy in patients with remission of rheumatoid arthritis. Joint Bone Spine 76(4):350–355. doi:10.1016/j.jbspin.2008.11.009 PubMedCrossRefGoogle Scholar
  5. 5.
    van den Broek M, Klarenbeek NB, Dirven L, van Schaardenburg D, Hulsmans HM, Kerstens PJ, Huizinga TW, Dijkmans BA, Allaart CF (2011) Discontinuation of infliximab and potential predictors of persistent low disease activity in patients with early rheumatoid arthritis and disease activity score-steered therapy: subanalysis of the Best study. Ann Rheum Dis 70(8):1389–1394. doi:10.1136/ard.2010.147751 PubMedCrossRefGoogle Scholar
  6. 6.
    Tanaka Y, Takeuchi T, Mimori T, Saito K, Nawata M, Kameda H, Nojima T, Miyasaka N, Koike T (2010) Discontinuation of infliximab after attaining low disease activity in patients with rheumatoid arthritis: RRR (remission induction by Remicade in RA) study. Ann Rheum Dis 69(7):1286–1291. doi:10.1136/ard.2009.121491 PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    van der Kooij SM, Goekoop-Ruiterman YP, de Vries-Bouwstra JK, Guler-Yuksel M, Zwinderman AH, Kerstens PJ, van der Lubbe PA, de Beus WM, Grillet BA, Ronday HK, Huizinga TW, Breedveld FC, Dijkmans BA, Allaart CF (2009) Drug-free remission, functioning and radiographic damage after 4 years of response-driven treatment in patients with recent-onset rheumatoid arthritis. Ann Rheum Dis 68(6):914–921. doi:10.1136/ard.2008.092254 PubMedCrossRefGoogle Scholar
  8. 8.
    Saleem B, Keen H, Goeb V, Parmar R, Nizam S, Hensor EM, Churchman SM, Quinn M, Wakefield R, Conaghan PG, Ponchel F, Emery P (2010) Patients with RA in remission on TNF blockers: when and in whom can TNF blocker therapy be stopped? Ann Rheum Dis 69(9):1636–1642. doi:10.1136/ard.2009.117341 PubMedCrossRefGoogle Scholar
  9. 9.
    Bathon JM, Martin RW, Fleischmann RM, Tesser JR, Schiff MH, Keystone EC, Genovese MC, Wasko MC, Moreland LW, Weaver AL, Markenson J, Finck BK (2000) A comparison of etanercept and methotrexate in patients with early rheumatoid arthritis. N Engl J Med 343(22):1586–1593. doi:10.1056/nejm200011303432201 PubMedCrossRefGoogle Scholar
  10. 10.
    Weinblatt ME, Keystone EC, Furst DE, Moreland LW, Weisman MH, Birbara CA, Teoh LA, Fischkoff SA, Chartash EK (2003) Adalimumab, a fully human anti-tumor necrosis factor alpha monoclonal antibody, for the treatment of rheumatoid arthritis in patients taking concomitant methotrexate: the ARMADA trial. Arthritis Rheum 48(1):35–45. doi:10.1002/art.10697 PubMedCrossRefGoogle Scholar
  11. 11.
    Wolfe F, Lassere M, van der Heijde D, Stucki G, Suarez-Almazor M, Pincus T, Eberhardt K, Kvien TK, Symmons D, Silman A, van Riel P, Tugwell P, Boers M (1999) Preliminary core set of domains and reporting requirements for longitudinal observational studies in rheumatology. J Rheumatol 26(2):484–489PubMedGoogle Scholar
  12. 12.
    van Vollenhoven RF, Brannemark S, Klareskog L (2004) Dose escalation of infliximab in clinical practice: improvements seen may be explained by a regression-like effect. Ann Rheum Dis 63(4):426–430PubMedCentralPubMedCrossRefGoogle Scholar
  13. 13.
    Welsing PM, Landewe RB, van Riel PL, Boers M, van Gestel AM, van der Linden S, Swinkels HL, van der Heijde DM (2004) The relationship between disease activity and radiologic progression in patients with rheumatoid arthritis: a longitudinal analysis. Arthritis Rheum 50(7):2082–2093. doi:10.1002/art.20350 PubMedCrossRefGoogle Scholar
  14. 14.
    Lipsky PE, van der Heijde DM, St Clair EW, Furst DE, Breedveld FC, Kalden JR, Smolen JS, Weisman M, Emery P, Feldmann M, Harriman GR, Maini RN (2000) Infliximab and methotrexate in the treatment of rheumatoid arthritis. Anti-Tumor Necrosis Factor Trial in Rheumatoid Arthritis with Concomitant Therapy Study Group. N Engl J Med 343(22):1594–1602. doi:10.1056/nejm200011303432202 PubMedCrossRefGoogle Scholar
  15. 15.
    Quinn MA, Conaghan PG, O’Connor PJ, Karim Z, Greenstein A, Brown A, Brown C, Fraser A, Jarret S, Emery P (2005) Very early treatment with infliximab in addition to methotrexate in early, poor-prognosis rheumatoid arthritis reduces magnetic resonance imaging evidence of synovitis and damage, with sustained benefit after infliximab withdrawal: results from a twelve-month randomized, double-blind, placebo-controlled trial. Arthritis Rheum 52(1):27–35. doi:10.1002/art.20712 PubMedCrossRefGoogle Scholar
  16. 16.
    Smolen JS, Beaulieu A, Rubbert-Roth A, Ramos-Remus C, Rovensky J, Alecock E, Woodworth T, Alten R (2008) Effect of interleukin-6 receptor inhibition with tocilizumab in patients with rheumatoid arthritis (OPTION study): a double-blind, placebo-controlled, randomised trial. Lancet 371(9617):987–997. doi:10.1016/s0140-6736(08)60453-5 PubMedCrossRefGoogle Scholar
  17. 17.
    Kievit W, Adang EM, Fransen J, Kuper HH, van de Laar MA, Jansen TL, De Gendt CM, De Rooij DJ, Brus HL, Van Oijen PC, Van Riel PC (2008) The effectiveness and medication costs of three anti-tumour necrosis factor alpha agents in the treatment of rheumatoid arthritis from prospective clinical practice data. Ann Rheum Dis 67(9):1229–1234. doi:10.1136/ard.2007.083675 PubMedCrossRefGoogle Scholar
  18. 18.
    van Vollenhoven RF (2009) How to dose infliximab in rheumatoid arthritis: new data on a serious issue. Ann Rheum Dis 68(8):1237–1239. doi:10.1136/ard.2009.111682 PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Jose Ramon Maneiro
    • 1
  • Eva Perez-Pampin
    • 1
  • Eva Salgado
    • 1
  • Loreto Carmona
    • 1
    • 2
  • Juan J. Gomez-Reino
    • 1
    • 3
  1. 1.Rheumatology DepartmentComplejo Hospitalario Universitario de Santiago de CompostelaSantiago de CompostelaSpain
  2. 2.Health Sciences SchoolUniversidad Camilo José CelaMadridSpain
  3. 3.Department of Medicine, Medical SchoolUniversidad de SantiagoSantiago de CompostelaSpain

Personalised recommendations