Dosing down with biologic therapies: a systematic review and clinicians' perspective.
The effectiveness of biologic therapies now means that remission or low disease activity are realistic targets for treatment. However, after achieving remission/low disease activity, the next steps remain unclear. The aim of this publication was to conduct a broad systematic literature review to evaluate dosing down of biologics. After screening papers and abstracts for relevance and application of inclusion/exclusion criteria, a structured extraction process was used to collect information on the included studies. Fifty-two papers were included in the analysis across rheumatic disease. In patients who discontinue therapy, remission is not typically sustained, with reported rates of relapse and flare across early RA (48-54%), established RA (2-84%), axial spondyloarthritis (11-53%) and PsA (44.9%). In many cases, an acceptable disease activity can be regained upon retreatment. More research is needed to understand the long-term impacts of these strategies on efficacy, safety and cost.
Musculoskeletal Research Unit, NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
Christopher J
CJ
Edwards
Pierre et Marie Curie University - Paris 6, Sorbonne Universités, Pierre Louis Institute of Epidemiology and Public Health, Paris, GRC-08 (EEMOIS).
Bruno
B
Fautrel
APHP, Rheumatology Department, Pitié Salpêtrière Hospital, Paris, F-75013, France.
Hendrik
H
Schulze-Koops
Division of Rheumatology and Clinical Immunology, Department of Medicine IV, Ludwig-Maximilians-Universität, Munich, Germany.
Tom W J
TWJ
Huizinga
Department of Rheumatology, Leiden University Medical Center, Leiden, C1-41, The Netherlands.
Klaus
K
Kruger
D000069594:Abatacept / Q000008:administration & dosage; D000068879:Adalimumab / Q000008:administration & dosage; D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D018501:Antirheumatic Agents / Q000008:administration & dosage*; D015535:Arthritis, Psoriatic / Q000188:drug therapy*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D001688:Biological Products / Q000008:administration & dosage*; D000068582:Certolizumab Pegol / Q000008:administration & dosage; D000068800:Etanercept / Q000008:administration & dosage; D006801:Humans; D000069285:Infliximab / Q000008:administration & dosage; D060046:Maintenance Chemotherapy; D012074:Remission Induction; D000069283:Rituximab / Q000008:administration & dosage; D025242:Spondylarthropathies / Q000188:drug therapy
D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D001688:Biological Products; D000069283:Rituximab; D000069594:Abatacept; C529000:golimumab; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept; D000068582:Certolizumab Pegol
axial spondyloarthritis; biologic therapy; dose spacing; dose tapering; dosing down; psoriatic arthritis; rheumatoid arthritis; systematic review; treatment withdrawal