title: Observational study of optimization of biologic therapies in rheumatoid arthritis: a single-centre experience.
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.
authors.affiliation: Rheumatology Department, Complejo Hospitalario Universitario de Santiago de Compostela, c/o Travesía da Choupana s/n, 15701, Santiago de Compostela, Spain, joseramon.maneiro.fernandez@sergas.es.
authors.forename: Jose Ramon
authors.initials: JR
authors.lastname: Maneiro
authors.forename: Eva
authors.initials: E
authors.lastname: Perez-Pampin
authors.forename: Eva
authors.initials: E
authors.lastname: Salgado
authors.forename: Loreto
authors.initials: L
authors.lastname: Carmona
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Gomez-Reino
mesh_terms: D000069594:Abatacept; D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D001688:Biological Products / Q000627:therapeutic use*; D001799:Blood Sedimentation; D005260:Female; D006801:Humans; D018796:Immunoconjugates / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013030:Spain; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D001688:Biological Products; D018796:Immunoconjugates; D000069594:Abatacept; C502936:tocilizumab
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