Biologic treatment spacing feasible for some rheumatic disease patients
medwireNews: Patients with rheumatic diseases who have stable disease remission or low disease activity might be able to reduce their biologic (b)DMARD treatment without disease flare by spacing their doses, BIOPURE findings show.
“Spacing of bDMARDs may be a feasible strategy for some patients with rheumatoid arthritis [RA], psoriatic arthritis [PsA] and axial spondyloarthritis [axSpA] who achieve the target and [have] withdrawn glucocorticoids,” write the researchers in Clinical Rheumatology.
“However, PsA patients might have greater odds of spacing failure because of skin psoriasis relapse,” explain Florenzo Iannone (University of Bari, Italy) and colleagues.
The registry study involved 37 patients with RA, 20 with axSpA, and 28 with PsA who were being treated at a single rheumatology outpatient clinic between January 2016 and December 2019. All the patients were taking a biologic and had been in disease remission or with low disease activity for at least 6 months without taking glucocorticoids.
Patients were offered a treatment spacing schedule whereby the gap between doses was generally doubled after a transition period of 3 months. Weekly subcutaneous bDMARDs, such as etanercept, were given every 2 weeks, while bDMARDs such as adalimumab normally administered every 2 weeks were administered every 4 weeks. Monthly golimumab was increased to every 2 months, abatacept and tocilizumab from every 4 weeks to every 8 weeks, and rituximab was reduced from two 1000 mg intravenous infusions every 6 months to one infusion.
When patients’ biologic treatment schedules were spaced out, 86.5% and 80.0% of RA and axSpA patients, respectively, remained on the schedule without experiencing flares, at corresponding mean drug survival times of 41 and 36 months.
The spacing strategy was less effective for PsA patients, however, with just 60.7% of patients remaining free of flare-ups, at a mean drug survival time of 30 months.
Over the 12 months of follow-up, joint flares occurred in five patients with RA and four with axSpA, whereas flares occurred in 11 patients with PsA, comprising joints in six patients and skin relapses in five.
The researchers say that “due to the skin or articular relapse, bDMARD spacing seems to be less effective in PsA patients,” but they add that “our speculations need to be confirmed, and a randomized controlled study might provide further data in this regard.”
Iannone et al stress the importance of patient selection for successful spacing, and say that “[u]sually, glucocorticoids are useful for reaching the clinical target, but once it is achieved, they may mask residual disease activity,” and therefore “the suspension of glucocorticoids should be a cornerstone before starting a bDMARD spacing strategy.”
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