Remicade treatment for RA, with dose titration based on the Disease Activity Score

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Ann Rheum Dis. 2004 Feb; 63(2): 144-8.

Infliximab treatment for rheumatoid arthritis, with dose titration based

on the Disease Activity Score: dose adjustments are common but not

always sufficient to assure sustained benefit.

Sidiropoulos P, Bertsias G, Kritikos HD, Kouroumali H, Voudouris K,

Boumpas DT.

University Hospital, Medical School, University of Crete, Heraklion,

Greece. First General Hospital of Thessaloniki " Agios Pavlos " ,

Thessaloniki, Greece.

BACKGROUND: Randomised controlled trials have shown that treatment with

anti-tumour necrosis factor (anti-TNF) agents is effective in refractory

rheumatoid arthritis (RA). OBJECTIVE: To determine the effectiveness of

anti-TNF in a general unselected group of patients with refractory RA.

METHODS: 68 patients with active RA despite treatment with disease

modifying antirheumatic drugs were studied during 12 infliximab

infusions. Infliximab (3 mg/kg/infusion) was given every 8 or 6 weeks.

Clinical efficacy was assessed by the Disease Activity Score (DAS) index

(44 joints). Dose adjustments were based on residual disease activity

(DAS score >2.4). The primary end points were the percentage of patients

achieving good or moderate response by the EULAR response criteria and

the proportion of patients requiring dose adjustment. RESULTS: 20 (29%)

patients discontinued treatment owing to side effects, early inefficacy,

or other considerations. Among the patients who continued treatment, 27

(56%) and 32 (67%) were responders on the 6th and 12th infliximab

infusion, respectively. In the same patients, disease activity gradually

improved without modifications in the initial dosing in 10 (21%),

whereas in 38 (79%) the dose of infliximab and/or methotrexate was

increased. Intensification of treatment led to a significant decrease in

the mean DAS score in this group (from 5.27 just before dose

modification to 4.54 before the 12th infusion, p<0.002). The EULAR

response category improved in only 10/38 (26%), however.

CONCLUSIONS: In this initial observational study of patients with RA

treated with recommended doses of infliximab, adjustments in treatment

were common but not always sufficient to maintain adequate disease

control. Longitudinal controlled trials are needed to define the optimal

dose escalation in patients with suboptimal response.

PMID: 14722202

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