title: Reduction of biological agent dose in rheumatic diseases: descriptive analysis of 153 patients in clinical practice conditions.
abstract: OBJECTIVE
  To analyze the frequency and characteristics of dose reduction of biological agents in a cohort of patients with chronic arthritis, in clinical practice conditions in a tertiary level hospital.
  
  
  METHODS
  Descriptive, cross-sectional study, which included all patients, followed consecutively during 6 months (June 2011-November 2011), by one investigator, with patients who at least have received one dose of biological agents in 2011.
  
  
  RESULTS
  We included 153 patients: Rheumatoid arthritis (RA) (n=82), ankylosing spondylitis (n=29), psoriatic arthritis (n=20), and miscellaneous group (n=22). Mean disease duration was 14.9±7.7 years. At the time of analysis, 70 patients (45.7%) were receiving low doses of biological therapy (50% in miscellaneous group group, 50% in psoriatic arthritis, 48.2% in ankylosing spondylitis, and 42.6% in RA). Mean time of dosage reduction was 17.4±17.5 months. The most common biological agents used in low dose were: etanercept, adalimumab and tocilizumab; 57.6%, 54.9% and 40% respectively, in patients with a reduced dose of biological therapy. The patients at low dose of biological therapy compared with standard dose, had similar mean disease duration, but received significantly less DMARDs, glucocorticoids and NSAIDs, and similar biological agent duration. RA patients with reduced biological treatment, at the time of analysis, had higher remission rates versus patients receiving a standard dose (82.9% vs 34%, p<0.0001). The medical decision at the time of analysis was to maintain low-dosage biological treatment in almost all patients.
  
  
  CONCLUSIONS
  In our clinical practice, 45.7% of our chronic arthritis patients receive low dose of biological therapy, after achieving remission or low activity at standard doses, maintaining a good control of the disease.
authors.affiliation: Unidad de Artritis, Servicio de Reumatología, Hospital Clínic de Barcelona, Barcelona, España.
authors.forename: José
authors.initials: J
authors.lastname: Inciarte-Mundo
authors.affiliation: Unidad de Artritis, Servicio de Reumatología, Hospital Clínic de Barcelona, Barcelona, España.
authors.forename: M Victoria
authors.initials: MV
authors.lastname: Hernández
authors.affiliation: Unidad de Artritis, Servicio de Reumatología, Hospital Clínic de Barcelona, Barcelona, España.
authors.forename: Violeta
authors.initials: V
authors.lastname: Rosario
authors.affiliation: Unidad de Artritis, Servicio de Reumatología, Hospital Clínic de Barcelona, Barcelona, España.
authors.forename: Virginia
authors.initials: V
authors.lastname: Ruiz-Esquide
authors.affiliation: Unidad de Artritis, Servicio de Reumatología, Hospital Clínic de Barcelona, Barcelona, España.
authors.forename: Sonia
authors.initials: S
authors.lastname: Cabrera-Villalba
authors.affiliation: Unidad de Artritis, Servicio de Reumatología, Hospital Clínic de Barcelona, Barcelona, España.
authors.forename: Julio
authors.initials: J
authors.lastname: Ramírez
authors.affiliation: Unidad de Artritis, Servicio de Reumatología, Hospital Clínic de Barcelona, Barcelona, España.
authors.forename: Juan D
authors.initials: JD
authors.lastname: Cañete
authors.affiliation: Unidad de Artritis, Servicio de Reumatología, Hospital Clínic de Barcelona, Barcelona, España. Electronic address: sanmarti@clinic.cat.
authors.forename: Raimon
authors.initials: R
authors.lastname: Sanmartí
mesh_terms: D000068879:Adalimumab; D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage* / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage* / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001168:Arthritis / Q000188:drug therapy*; D015535:Arthritis, Psoriatic / Q000188:drug therapy; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D000068800:Etanercept; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000008:administration & dosage* / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D018124:Receptors, Tumor Necrosis Factor / Q000008:administration & dosage* / Q000627:therapeutic use; D012189:Retrospective Studies; D013167:Spondylitis, Ankylosing / Q000188:drug therapy; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D018124:Receptors, Tumor Necrosis Factor; D000069285:Infliximab; D000068879:Adalimumab; C502936:tocilizumab; D000068800:Etanercept
keywords: Artropatías crónicas; Biological therapy; Chronic arthritis; Dose reduction; Reducción de dosis; Terapia biológica