Sustained effect after lowering high-dose infliximab in patients with rheumatoid arthritis: a prospective dose titration study

Abstract

Infliximab dosages of 5 mg/kg can be lowered in the majority of patients with RA using DAS28-guided dose titration without increase of disease activity. Lowering the dose of infliximab should be considered in every patient receiving higher doses infliximab.

When to initiate and discontinue biologic treatments for rheumatoid arthritis?

“…This observation suggests that the improvements were most probably attributable to regression to the mean and that no important benefit is gained from dose increases of infliximab. Finally, van den Bemt et al [33] found that 17 of 18 patients who were in clinical practice treated with infliximab at dosages higher than 3 mg kg )1 showed no deterioration of their RA if the dosage was reduced to 3 mg kg ) 1 . In conclusion, the evidence suggests that increasing the dose of infliximab might result in loss of time, higher cost and potentially more side effects with no significant efficacy gain in most patients.…”

Dose-Tapering Of TNF Inhibitors in Daily Rheumatology Practice Enables the Maintenance of Clinical Efficacy While Improving Cost-Effectiveness

“…Other potential restrictions of such strategies are the risks of increasing the number of flares, the consequent loss of TNFi benefits and the need to enhance concomitant therapy (NSAIDs, corticosteroids and/or classic DMARDs). However, previous studies about dose titration in longstanding RA patients demonstrated that this strategy is feasible in the majority of patients without experiencing relevant/remarkable changes in clinical outcomes [4,5,7]. In a cohort of 51 RA patients with Ifx Van der Maas et al observed that dose titration was feasible in patients with inactive disease and also demonstrated important cost savings with this strategy [4].…”

“…The fact that biologics consume a growing portion of health care budgets has resulted in an increased attention towards therapy optimization [2,3]. Recently, it has been shown that dose tapering of TNFi is a feasible therapeutic option in rheumatic patients with low disease activity (LDA) [4][5][6][7][8][9][10]. However, concerns about the risk of disease flares, the progression of radiological damage and the need to increase other medications with potential side effects have limited its implementation.…”

Dose escalation of certolizumab pegol from 200 mg to 400 mg every other week provides no additional efficacy in rheumatoid arthritis: An analysis of individual patient‐level data

“…Additionally, in contrast to our analyses, these earlier reports often presented the effects of dose escalation as group means rather than at an individual level, thereby obscuring any potential benefit for selected patients. Further support for the limited benefit of dose escalation of TNF inhibitor therapy for most patients (whose mean Ϯ SD DAS28 prior to a dose decrease was 3.2) was demonstrated in a study in which only 1 of 18 RA patients receiving infliximab experienced a disease flare after the dose was lowered from 5 mg/kg to 3 mg/kg (15).…”