title: Comparing a tapering strategy to the standard dosing regimen of TNF inhibitors in rheumatoid arthritis patients with low disease activity.
abstract: OBJECTIVE
  The aim of this study is to compare clinical outcomes, incidence of flares and administered drug reduction between rheumatoid arthritis (RA) patients under TNF inhibitors (TNFi) tapering strategy and RA patients on standard regimen.
  
  
  METHODS
  Two groups of RA patients on TNFi with DAS28<3.2 were compared: the tapering group (TG: 67 pts from Spain) and the control group with standard therapy regimen (CG: 77 pts from the Netherlands). DAS28 was measured at different time points: visit 0 (prior starting TNFi), visit 1 (prior to start tapering in TG and with DAS28<3.2 in TG and CG), visit 2 (6 months after visit 1), visit 3 (1 year after visit 1), visit 4 (the last visit available after visit 1) and visit-flare (visit with the worst flare between visit 1 and visit 4).
  
  
  RESULTS
  Despite the reduction of administered drug at visit 4 in the TG (interval elongation of 32.8% in infliximab, 52.9% in adalimumab and 52.6% in etanercept), the DAS28 remained similar between groups at the end of the study (DAS28: 2.7±0.9 in TG vs. 2.5±1 in CG, p=0.1). No differences were seen in the number of patients with flares [26/67 (38.9%) in the TG vs. 30/77 (39%) in the CG, p=0.324] and only nineteen out of 136 patients (14%) had anti-drug antibodies at the end of the study.
  
  
  CONCLUSIONS
  The tapering strategy of TNFi in RA patients result in a reduction of the drug administered, while the disease control is not worse than patients on the standard regimen.
authors.affiliation: Department of Rheumatology, La Paz University Hospital-Idipaz, Madrid, Spain. chamiplaro@gmail.com.
authors.forename: Chamaida
authors.initials: C
authors.lastname: Plasencia
authors.affiliation: Jan van Breemen Research Institute/Reade, Amsterdam; and Department of Rheumatology, V.U. University Medical Centre, Amsterdam, The Netherlands.
authors.forename: Gertjan
authors.initials: G
authors.lastname: Wolbink
authors.affiliation: Jan van Breemen Research Institute/Reade, Amsterdam, The Netherlands.
authors.forename: Charlotte L M
authors.initials: CL
authors.lastname: Krieckaert
authors.affiliation: Jan van Breemen Research Institute/Reade, Amsterdam, The Netherlands.
authors.forename: Eva L
authors.initials: EL
authors.lastname: Kneepkens
authors.affiliation: Jan van Breemen Research Institute/Reade, Amsterdam, The Netherlands.
authors.forename: Samina
authors.initials: S
authors.lastname: Turk
authors.affiliation: Immunology Unit, La Paz University Hospital-Idipaz, Madrid, Spain.
authors.forename: Teresa
authors.initials: T
authors.lastname: Jurado
authors.affiliation: Department of Rheumatology, V.U. University Medical Centre, Amsterdam, The Netherlands.
authors.forename: Ana
authors.initials: A
authors.lastname: Martínez-Feito
authors.affiliation: Department of Rheumatology, La Paz University Hospital-Idipaz, Madrid, Spain.
authors.forename: Victoria
authors.initials: V
authors.lastname: Navarro-Compán
authors.affiliation: Department of Rheumatology, La Paz University Hospital-Idipaz, Madrid, Spain.
authors.forename: Gema
authors.initials: G
authors.lastname: Bonilla
authors.affiliation: Department of Rheumatology, La Paz University Hospital-Idipaz, Madrid, Spain.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Villalba
authors.affiliation: Department of Rheumatology, La Paz University Hospital-Idipaz, Madrid, Spain.
authors.forename: Diana
authors.initials: D
authors.lastname: Peiteado
authors.affiliation: Department of Rheumatology, La Paz University Hospital-Idipaz, Madrid, Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Nuño
authors.affiliation: Department of Rheumatology, La Paz University Hospital-Idipaz, Madrid, Spain.
authors.forename: Emilio
authors.initials: E
authors.lastname: Martín-Mola
authors.affiliation: Jan van Breemen Research Institute/Reade, Amsterdam; and Department of Rheumatology, V.U. University Medical Centre, Amsterdam, The Netherlands.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Nurmohamed
authors.affiliation: Sanquin Diagnostic Services, Amsterdam, The Netherlands.
authors.forename: Desiree
authors.initials: D
authors.lastname: van der Kleij
authors.affiliation: Department of Immunopathology, Sanquin Research and Landsteiner Laboratory Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Theo
authors.initials: T
authors.lastname: Rispens
authors.affiliation: Immunology Unit, La Paz University Hospital-Idipaz, Madrid, Spain.
authors.forename: Dora
authors.initials: D
authors.lastname: Pascual-Salcedo
authors.affiliation: Department of Rheumatology, La Paz University Hospital-Idipaz, Madrid, Spain.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Balsa
mesh_terms: D000368:Aged; D018501:Antirheumatic Agents / Q000008:administration & dosage* / Q000097:blood; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D001688:Biological Products / Q000008:administration & dosage* / Q000097:blood; D004185:Disability Evaluation; D004334:Drug Administration Schedule; D016903:Drug Monitoring; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013030:Spain; D013997:Time Factors; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000276:immunology
chemical_list: D018501:Antirheumatic Agents; D001688:Biological Products; D014409:Tumor Necrosis Factor-alpha