REVIEW - Dose escalation of the anti-TNF-alpha agents in patients with RA

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Rheumatology (Oxford). 2007 Mar;46(3):529-32. Epub 2006 Sep 29.

Dose escalation of the anti-TNF-alpha agents in patients with

rheumatoid arthritis. A systematic review.

Ariza-Ariza R, Navarro-Sarabia F, Hernández-Cruz B, Rodríguez-Arboleya

L, Navarro-Compán V, Toyos J.

Rheumatology Service, Hospital Universitário Virgen Macarena, Seville, Spain.

OBJECTIVE: To estimate the proportion of rheumatoid arthritis (RA)

patients on anti-tumour necrosis factor (anti-TNF) who require dose

escalation.

METHODS: Systematic review of the scientific literature. Infliximab,

etanercept and adalimumab studies in RA were considered. Primary

outcome was the proportion of patients requiring dose escalation.

American College Rheumatology (ACR) and Disease activity score (DAS)

responses post-escalation were assessed when available.

RESULTS: From 1801 references, 16 studies with 8510 patients were

included. Of all the infliximab patients, 53.7% underwent dose

escalation. Fourty-four per cent of the infliximab patients

experienced dose increase and 8.3%, frequency increase. The ACR20

response to dose escalation ranged from 27 to 36% and DAS28 improved

from 5.2 to 4.5 in one study and from 4.1 to 3.7 in another. Of the

etanercept patients, 17.5% experienced a dose increase but changes on

the mean dose were not statistically significant.

CONCLUSIONS: Dose escalation is common in patients treated with

infliximab, and less frequent with etanercept. In a proportion of

patients, the dose escalation seems effective. The design and evidence

level of the available studies limit the strength of the conclusions.

PMID: 17012439

http://www.ncbi.nlm.nih.gov/pubmed/17012439

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