TY - JOUR T1 - Biological Dose Tapering in Daily Clinical Practice: A 10 Year Follow-up Study JO - Reumatología Clínica T2 - AU - Alperi-López,Mercedes AU - Alonso-Castro,Sara AU - Morante-Bolado,Isla AU - Queiro-Silva,Rubén AU - Riestra-Noriega,José Luis AU - Arboleya,Luis AU - Ballina-García,Francisco Javier SN - 1699258X M3 - 10.1016/j.reuma.2018.08.002 DO - 10.1016/j.reuma.2018.08.002 UR - https://reumatologiaclinica.org/es-biological-dose-tapering-in-daily-articulo-S1699258X18301827 AB - ObjectiveTo describe practice patterns, long-term outcome, and related factors, in relation to biological therapies tapering in rheumatoid arthritis (RA) patients in a well-controlled real-world setting. MethodsAn observational longitudinal retrospective 10-year study was conducted in all RA patients receiving biological agents in an RA clinic from May 2003 to October 2013. Biological treatment of patients with sustained DAS28<3.2 or SDAI<11 was tapered (dose down-titrated or interval widen) or discontinued as per practice protocol. Primary outcome of tapering was relapse, defined as an increase in DAS28≥1.2. Descriptive, survival analysis, and logistic regression analysis with first relapse as dependent variable were carried out. ResultsOf 193 RA patients on biological treatment (mean age 54±14 years, 81% women), tapering was applied in 106 (55%) and discontinuation in 34 (17.6%). During follow-up 38 patients relapsed (62%). Rate of relapse was 10% at 6 months, 19% at 12 months, 33.2% at 2 years and 50% after 5 years. Mean time in dose reduction was 4.5 years [95% confidence interval (95% CI): 3.7–5.3]. Six patients (15.7%) did not respond after reinstatement of full dose of biologic. In the multivariate analysis, pain [OR=1.26 (95% CI: 1.11–1.43); P<.001] and erythrocyte sedimentation rate (ESR) [OR=1.01 (95% CI: 1.00–1.03); P=.011] at baseline were associated with relapse after tapering. ConclusionsTapering may be considered a long-term option in RA patients on biologics and low disease activity, especially if low ESR and pain scores are present at baseline; treatment reinstatement could be considered a safe option in case of relapse. ER -