Comparison between full and tapered dosages of biologic therapies in psoriatic arthritis patients: clinical and ultrasound assessment

Abstract

The primary objective of this study was to describe and compare clinical and musculoskeletal (MS) ultrasound (US) features between psoriatic arthritis (PsA) patients treated with full and tapered dosage of biologic (b) disease-modified antirheumatic drugs (DMARDs). The secondary objective was to compare clinical and MSUS features between PsA patients treated with bDMARDs with and without concomitant synthetic (s) DMARDs. We evaluated 102 patients with PsA treated with bDMARDs. The bDMARD dosage tapering had been made in patients with a maintained remission or minimal disease activity (MDA) according to their attending rheumatologist and with the patient acceptance. The bDMARD tapering consisted of the following: increase the interval between doses for subcutaneous bDMARDs or reduction of the dose for intravenous bDMARDs. The clinical evaluation consisted of a dermatologic and rheumatologic assessment of disease activity. The presence of B-mode and Doppler synovitis, tenosynovitis, enthesopathy, and paratenonitis was investigated by a rheumatologist blinded to drug dosage, clinical assessments, and laboratory results. Seventy-four (72.5 %) patients received full dosage of bDMARDs and 28 (27.5 %) received tapered dosage. The duration with biologic therapy and with current biologic therapy was significantly higher in patients with tapered dosages (p = 0.008 and p = 0.001, respectively). We found no significant differences between clinical, laboratory, and US variables, both for BM and CD between patients with full and tapered dosage and between patients with and without concomitant sDMARD. Clinical assessment, MSUS variables, and MDA status are similar in patients receiving full and tapered dosage of bDMARDs.

Adalimumab Dose Tapering in Psoriasis: Predictive Factors for Maintenance of Complete Clearance

“…Sustained complete clearance in long-term follow-up (4-6 years) in all patients in our study and short time to re-achieve PASI-100 in group B patients (1 month) exclude the risk of anti-drug antibody due to dose tapering (27). In concordance with previous studies in PsA, our patients with concomitant PsA did not show neither clinical nor serological relapse, independent of treatment dose (16).…”

“…Adalimumab dose tapering, obtained either by increasing the interval between doses or by reducing dosage, was previously and successfully reported in a consistent proportion of patients with rheumatoid arthritis (12,13), ankylosing spondylitis (14,15), and with PsA (16). Dose tapering of adalimumab is rarely reported in PsO (17)(18)(19)(20)(21), and there is no evidence regarding predictive factors to define the profile of patients suited to this drug-specific therapeutic strategy.…”

EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2019 update

“…Sparse data suggest a certain risk of relapse (either for joints or skin) when tapering. [90][91][92][93][94][95] Still, the taskforce decided to offer guidance on tapering, since it was felt an important aspect of modern management, especially when sustained remission has been achieved, to mitigate treatment-related risks, to meet patients' desires and demands, and to reduce cost of treatment.…”

Management of Patients with Psoriatic Arthritis – Analysis and Discussion of the Main Points of the EULAR Recommendations 2019

“…Это новая рекомендация, в первую очередь, основаная на широком консенсусе экспертов в отсутствие достоверных данных исследований. Небольшое количество данных предполагают определенный риск рецидива (для суставов или кожи) при снижении дозы [27,31]. Тем не менее рабочая группа решила предложить эту рекомендацию, так как посчитали это важным аспектом современного менеджмента.…”