title: Minimum effective dosages of anti-TNF in rheumatoid arthritis: a cross-sectional study.
abstract: OBJECTIVE
  To evaluate the modified dosages of anti-TNF in controlling disease activity in rheumatoid arthritis (RA) measured by DAS28-ESR.
  
  
  METHODS
  Cross-sectional study: RA patients treated with etanercept (ETN), adalimumab (ADA) or infliximab (IFX), at standard or modified doses.
  
  
  METHODS
  dosage, concomitant disease modifying drugs (DMARDs), DAS28-ESR.
  
  
  RESULTS
  195 RA patients included (79% women, mean age 58.1 years): ETN=81, ADA=56, IFX=58. Mean disease duration and time to first biological treatment was higher in IFX group (P=.01). Patients distribution by dosage: standard: ETN (72.8%), ADA (69.6%), IFX (27.6%); escalated: IFX (69%), ADA (5.4%), ETN (0%); reduced: ETN (27.1%), ADA (25%), IFX (3.4%). Concomitant DMARDs use was lower in ETN (58.2%) than ADA (66.07%) and IFX (79.31%). Higher proportion of responders (DAS28 ≤3.2) in ADA (65.3%) and ETN (61.7%) than IFX (48.3%).
  
  
  CONCLUSIONS
  RA clinical control can be preserved with modified anti-TNF dosages. Controlled prospective studies should be performed to define when therapy can be tailored and for which patients.
authors.affiliation: Rheumatology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain. Electronic address: Inma.torre.ortega@googlemail.com.
authors.forename: Inmaculada
authors.initials: I
authors.lastname: de la Torre
authors.affiliation: Rheumatology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Lara
authors.initials: L
authors.lastname: Valor
authors.affiliation: Rheumatology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Nieto
authors.affiliation: Rheumatology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Montoro
authors.affiliation: Rheumatology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Carreño
mesh_terms: D000068879:Adalimumab; D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D003430:Cross-Sectional Studies; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D000068800:Etanercept; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use*; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept
keywords: Adalimumab; Ajuste de la dosis; Anti-TNF; Artritis reumatoide; DAS28; Dosage titration; Etanercep; Etanercept; Infliximab; Rheumatoid arthritis