Avtor/Urednik		Chen, Der-Yuan; Lau, Chak Sing; Elzorkany, Bassel; Hsu, Ping-Ning; Praprotnik, Sonja; Vasilescu, Radu; Marshall, Lisa; Llamado, Lyndon
Naslov		Dosing down and then discontinuing biologic therapy in rheumatoid arthritis
Tip		članek
Vol. in št.		Letnik 21, št. 2
Leto izdaje		2018
Obseg		str. 362-372
ISSN		1756-1841 - International journal of rheumatic diseases
Jezik		eng
Abstrakt		Aim To review the published studies that dose down and then discontinue biologic therapy in patients with rheumatoid arthritis (RA), particularly concerning the criteria for such dosing and the impact on clinical outcomes. Methods Published studies conducted in patients with RA that sequentially decreased the dose and then discontinued therapy were included if one or more of the following biologic disease modifying antirheumatic drugs (bDMARDs) was evaluated: abatacept, adalimumab, certolizumab, etanercept, golimumab, infliximab, rituximab or tocilizumab. Results Five studies qualified for inclusion. The populations of patients with RA were heterogeneous among the studies; patients were required to have low disease activity (LDA) or to be in remission prior to dose titration. Approximately 25%65% of patients successfully decreased and in some cases, discontinued the bDMARD. However, the flare rate was higher than for the patients who remained on a standard dose. The only variable that predicted relapse in more than one study was down-titration of the bDMARD dose. Conclusion In patients who have achieved LDA or remission, down-titration and discontinuation of bDMARD therapy may be attempted, with careful monitoring. However, it is likely that some patients will flare, and it is not known how to predict these patients.
Proste vsebinske oznake		biologic therapy down-titration rheumatoid arthritis biološka terapija znižanje titracije revmatoidni artritis