title: Are there dangers in biologic dose reduction strategies?
abstract: Biologic dose reduction strategies, for patients with inflammatory rheumatic diseases, have been assessed in multiple studies to assess outcomes compared to ongoing maintenance dosing. Whilst cessation in established disease usually leads to disease flare, dose tapering approaches for those achieving low disease activity often appear to be successful in the short term. However, tapering can be associated with a higher risk of losing disease control and rates of recapture of disease control using the original biologic dose vary between studies. Over relatively short periods of follow-up, a number of studies have shown no statistical difference in radiographic progression in patients tapering or discontinuing biologics. However, a Cochrane review found that radiographic and functional outcomes may be worse after TNF inhibitor discontinuation, and over long-term disease follow-up flares have been associated with radiographic progression and worse patient reported outcomes. To date, no studies of biological therapy dose reduction have specifically investigated the risk of increased immunogenicity or the effects on cardiovascular risk and other co-morbidities, although these remain important potential risks. In addition, whether there are greater dangers in certain dose reduction approaches such as a reduction in dose at the same frequency or a spacing of doses is not established.
authors.affiliation: University Hospital Southampton NHS Foundation Trust, Southampton, UK.
authors.forename: Christopher K Y
authors.initials: CK
authors.lastname: Chan
authors.affiliation: University Hospital Southampton NHS Foundation Trust, Southampton, UK.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Holroyd
authors.affiliation: University Hospital Southampton NHS Foundation Trust, Southampton, UK.
authors.forename: Alice
authors.initials: A
authors.lastname: Mason
authors.affiliation: MSK Research Unit, NIHR Wellcome Trust Clinical Research Facility, University of Southampton, UK.
authors.forename: Jalaa
authors.initials: J
authors.lastname: Zarroug
authors.affiliation: University Hospital Southampton NHS Foundation Trust, Southampton, UK; MSK Research Unit, NIHR Wellcome Trust Clinical Research Facility, University of Southampton, UK. Electronic address: cedwards@soton.ac.uk.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Edwards
mesh_terms: D001685:Biological Factors / Q000627:therapeutic use*; D018450:Disease Progression; D004305:Dose-Response Relationship, Drug; D006801:Humans; D012307:Risk Factors; D013997:Time Factors
chemical_list: D001685:Biological Factors
keywords: Biologic; Dose; Reduction; Risk; Taper