Background/Purpose: Down-titration of biological therapy (BT) in rheumatoid arthritis (RA) patients with a good clinical response is frequently applied in daily clinical practice. An important factor in order to know if this can be safely applied is the response to retreatment in flaring patients. We have analyzed the risk of relapse and the effectiveness of retreatment in RA patients receiving BT (in daily clinical practice) who had been previously down-titrated.

Methods: Retrospective observational study from a single center. RA patients receiving BT (infliximab, adalimumab, etanercept, certolizumab pegol, abatacept and tocilizumab) previously down-titrated (quarterly dose of BT less than or equal to 83% of the approved dose) were included. Retreatment consisted of increasing the dose to previous or standard (European Medicines Agency approved) dose, at the discretion of the attending physician. Relapse was defined as an increase greater than or equal to 0.6 points from baseline DAS28 or according to the attending physician criteria. Response to retreatment was considered if patients achieved the same level of DAS28 (remission, low or moderate disease activity) as prior to down-titration. Numerical data are expressed as mean and standard deviation for continuous variables and percentages for qualitative variables. Univariate and multivariate analysis was used in order to identify potential predictors of greater risk of relapse after BT down-titration.

Results: Two hundred and fifty-six RA patients were under BT and 91 patients were down-titrated of whom 52% were in remission, 24% with low disease activity and 24% with moderate disease activity according to DAS28. Most patients (68.1%) were receiving first line BT. Twenty eight patients relapsed and received retreatment at full dose (61%) or previous dose (39%). The average time between down-titration and retreatment was 17.2 ± 13.7 months. Mean DAS28 at the time of retreatment was 4.01 ± 0.99. Most patients (75%) achieved a clinical response before 6 months of retreatment, regardless the use of standard or previous dose. No statistically significant predictors of flare were identified although a trend to greater risk of flaring was observed in patients not in remission at down-titration.

Conclusion: Although down-titration carries a risk of relapse in RA, most patients achieve a good response after retreatment.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/biological-down-titration-in-ra-patient-profile-and-response-to-retreatment-in-flaring-patients/