title: Pattern of infliximab utilization in rheumatoid arthritis patients at an academic medical center.
abstract: OBJECTIVE
  To investigate the pattern of use of infliximab with an emphasis on treatment escalation and the durability of infliximab use in the management of rheumatoid arthritis (RA) in an academic setting.
  
  
  METHODS
  We conducted a retrospective review of pharmacy and medical records of 183 patients with RA who received at least 1 infliximab infusion at the infusion centers of the Brigham and Women's Hospital. Treatment escalation was defined as an increase in the dosage of infliximab to >3 mg/kg and/or a decrease in the dosing interval to <7 weeks between infusions.
  
  
  RESULTS
  A total of 183 patients with RA received infliximab infusions for a mean +/- SD duration of 58.2 +/- 56.6 weeks. Infliximab was discontinued in 48% of the patients during the first year of therapy and in 67% of the patients overall. A total of 126 patients had a treatment escalation, including 25 patients with a dose increase, 35 patients with a decrease in the interval, and 66 patients with both. Infliximab treatment was associated with a decrease in corticosteroid and methotrexate doses. Patients who had a treatment escalation were more likely to continue infliximab infusions compared with patients without a treatment escalation (odds ratio 2.0, 95% confidence interval 1.0-4.1).
  
  
  CONCLUSIONS
  The use of infliximab may be an effective treatment for RA; however, a substantial number of patients will discontinue its use. Treatment escalation is commonly used in the management of RA with infliximab and is associated with longer duration of infliximab use.
authors.affiliation: Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
authors.forename: Sandeep K
authors.initials: SK
authors.lastname: Agarwal
authors.forename: Agnes L
authors.initials: AL
authors.lastname: Maier
authors.forename: Lori B
authors.initials: LB
authors.lastname: Chibnik
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Coblyn
authors.forename: Anne
authors.initials: A
authors.lastname: Fossel
authors.forename: Ryan
authors.initials: R
authors.lastname: Lee
authors.forename: John
authors.initials: J
authors.lastname: Fanikos
authors.forename: Karen
authors.initials: K
authors.lastname: Fiumara
authors.forename: Colleen
authors.initials: C
authors.lastname: Lowry
authors.forename: Michael E
authors.initials: ME
authors.lastname: Weinblatt
mesh_terms: D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D000069285:Infliximab; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D012189:Retrospective Studies; D016312:Treatment Refusal / Q000706:statistics & numerical data
chemical_list: D000911:Antibodies, Monoclonal; D007155:Immunologic Factors; D000069285:Infliximab