RESEARCH - Dose escalation of Remicade therapy in arthritis patients is related to diagnosis and concomitant MTX

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Rheumatology Advance Access published online on December 23, 2008

Rheumatology, doi:10.1093/rheumatology/ken467

Dose escalation of infliximab therapy in arthritis patients is related

to diagnosis and concomitant methotrexate treatment: observational

results from the South Swedish Arthritis

Treatment Group register

L. E. sen1, P. Geborek1 and T. Saxne1

1Department of Rheumatology, Lund University Hospital, Lund, Sweden.

Abstract

Objective. To study frequency of dose escalation in infliximab-treated

patients and to identify possible predictors thereof.

Methods. Patients with chronic arthritis initiating their first course

of anti-TNF treatment with infliximab at Lund University Hospital were

included in a structured clinical follow-up protocol. Information on

diagnosis, drug dosage, disease duration, previous and ongoing DMARDs,

treatment start and cessation were prospectively collected during the

period March 1999 through February 2007. All patients were started on

a dose of 3 mg/kg at time 0, week 2, week 6 and then every eighth week

independent of diagnosis and were followed for a period of 2 yrs.

Results. A total of 206 patients were included in the study.

Thirty-two of the patients had PsA, 25 had AS and 149 patients had RA.

A minor dose escalation, defined as less than doubling of the dosage,

was observed for 53, 48 and 42% of the patients with PsA, AS and RA,

respectively. The corresponding values for major dose escalation was

observed for 19, 8 and 15% of the patients, respectively. Regression

analysis showed that patients with a diagnosis of PsA (P = 0.03),

longer follow-up period (P < 0.01), and lack of concomitant MTX

treatment (P = 0.03) were significantly associated with risk of dose

escalation.

Conclusion. Dose escalations were performed in 59% of all

infliximab-treated patients during the first 2 yrs of treatment. Our

data suggest that PsA patients might require higher dosages than RA

and AS patients.

http://rheumatology.oxfordjournals.org/cgi/content/abstract/ken467v1?papetoc

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