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Titration of Remicade (infliximab) treatment in RA patients based on response patterns

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Titration of infliximab treatment in rheumatoid arthritis patients based on

response patterns

Rheumatology 2007 46(1):146-149; doi:10.1093/rheumatology/kel173

http://rheumatology.oxfordjournals.org/cgi/content/abstract/46/1/146

Abstract

Objectives. To observe the course of the disease activity in rheumatoid

arthritis (RA) patients treated with the standard infliximab dosing regimen

and to adjust treatment guided by the pattern of disease activity.

Methods. All RA patients starting infliximab treatment were included and

observed for at least 37 weeks. At infusion 4 (week 14), European League

Against Rheumatism response was assessed.

In moderate responders the dose was unchanged and the disease activity was

carefully observed.

In case of stable disease activity, the dose was increased at infusion 5

(week 22).

In case of a temporary response the interval was reduced. Paired t-testing

was applied to the disease activity score with 28-joint counts (DAS28) at

week 22 and study endpoint.

Results. A total of 76 patients were included. Response after 14 weeks:

good 22 (29%) patients, moderate 26 (34%) patients, and non-response in 21

patients.

Seven patients (9%) dropped out before week 14 due to adverse events (5) or

patients' initiative (2).

In patients with moderate response, the following disease course between

infusion 4 and 5 was observed: improvement to good response 6, temporary

response 6, stable disease activity 6, drop out 8. In moderate responders,

interval reduction and dose increase resulted in a decrease in mean DAS28

from 5.1 to 3.6 [P = 0.005, mean interval 5.6 weeks, mean infliximab dose

4.8 mg/kg/8 week (endpoint)] and from 4.1 to 3.6 [P = 0.04, mean infliximab

dose 7.3 mg/kg/8 week (endpoint)], respectively.

Conclusion. Three different patterns of disease activity were observed in

moderate responders after 14 weeks of infliximab treatment, i.e. further

improvement, no change in disease activity or a temporary response. Both

interval reduction and dose increase significantly reduced disease activity,

however, with different mean infliximab dosages. In good responders the

response was often sustained over follow-up, whereas non-responders showed

modest or no improvement despite dose adjustments.

Correspondence to: M. C. W. Creemers, MD, Department of Rheumatology,

Radboud University Nijmegen Medical Centre, PO Box 9101, Postal code 6500

HB, Nijmegen, The Netherlands. E-mail: m.creemers@...

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