Dosing down and then discontinuing biologic therapy in rheumatoid arthritis: A review of the literature
Journal
International Journal of Rheumatic Diseases
Journal Volume
21
Journal Issue
2
Pages
362-372
Date Issued
2018
Author(s)
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. ? 2017 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.
Subjects
Biologic; Discontinuation; Down-titration; Rheumatoid arthritis
Other Subjects
abatacept; adalimumab; certolizumab pegol; etanercept; golimumab; infliximab; interleukin 1 receptor blocking agent; interleukin 6 receptor; rituximab; tocilizumab; tumor necrosis factor inhibitor; antirheumatic agent; biological product; biological therapy; clinical outcome; disease activity; disease duration; drug dose titration; drug monitoring; drug screening; drug withdrawal; human; prediction; priority journal; remission; Review; rheumatoid arthritis; T lymphocyte activation; treatment withdrawal; cost benefit analysis; drug administration; drug cost; economics; immunology; recurrent disease; rheumatoid arthritis; time factor; treatment outcome; Antirheumatic Agents; Arthritis, Rheumatoid; Biological Products; Cost-Benefit Analysis; Drug Administration Schedule; Drug Costs; Humans; Recurrence; Remission Induction; Time Factors; Treatment Outcome
Publisher
Blackwell Publishing
Type
review