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Background: Published experiences on the optimization of biological treatment in patients with RA in sustained clinical remission, seem to demonstrate that its results are not inferior to those of continuing with the standard dose. This therapeutic strategy is carried out in clinical practice empirically, since there are no specific recommendations in clinical guidelines. Objectives: The objective of this work is to evaluate the effectiveness of a biological treatment dose optimization strategy in patients with RA in maintained clinical remission, treated in the Rheumatology Unit of the Valme University Hospital. Methods: Observational, descriptive, retrospective study conducted in a secondary hospital in Spain. Inclusion criteria were: patients aged 18 years or older, diagnosed with RA (2010 ACR-EULAR criteria), undergoing biological treatment, who have reduced their dose at some point in their evolution because of clinical remission, maintained for at least 6 months. Main variable was "therapeutic objective met" 12 months after starting the dose reduction, which is understood as maintenance of clinical remission or, failing that, low disease activity, based on an objective measure (DAS28 ≤ 2.6 or ≤ 3.2 respectively). The variables collected were: demographics, related to disease characteristics, and related to clinical activity. Variables related to treatment were also collected, as well as adverse events occurred during follow-up. Results: Eighty-two patients with the following characteristics (see Table 1) were included. At 12 months, 74% of patients maintained a DAS28 ≤ 3.2 (low activity or remission), compared to 26% who showed DAS28 greater than 3.2 (moderate or high activity). 42.8% of patients maintained clinical remission status (DAS28 ≤ 2.6) at 12 months: mean DAS28 1.97 (95% CI 1.79-2.15). The effectiveness was also evaluated after successive dose reductions of the biological (see Figure 1). Regarding the predictors of success of optimization: 76.7% of CCP-negative patients maintained DAS28 ≤ 3.2 during follow-up, compared to 55.1% of CCP-positive patients (p 0.06, OR 2.67). 70.7% of patients without RA complications maintained DAS28 ≤ 3.2 compared to 45.8% of patients with complications of the disease, (p 0.045, OR 2.85), and 74.4% of patients without corticosteroids at the starting of optimization maintained DAS28 ≤ 3.2 compared to 51.3% of patients with corticosteroids (p 0.040, OR 2.76). Follow-up time 20.28 ± 6.26 years. Conclusion: Biological optimization through a specific protocol adjusted to RA activity is an effective therapeutic option for a high proportion of patients, with a 74% probability of remaining in low activity or clinical remission and a 42.8% probability of persistence of clinical remission at one year. The effectiveness of biologic optimization is maintained over time, with the percentage of patients maintaining low activity or clinical remission being greater than 70% after each reduction step. The absence of anti-CCP, RA complications and corticosteroids at the beginning of the dose reduction could define a patient profile more suitable for dose optimization. REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests: None declared.
Montero et al. (Sat,) studied this question.