Dose escalation of certolizumab pegol from 200 mg to 400 mg every other week provides no additional efficacy in rheumatoid arthritis: An analysis of individual patient‐level data

Abstract

Objective. To determine whether certolizumab pegol (CZP) dosage escalation from 200 mg to 400 mg every other week benefits some patients with rheumatoid arthritis (RA).Methods Results. In the group of patients who had completed the RAPID 1 study and had moderate or severe disease activity at entry into the open-label study, and in those who had been withdrawn early from the RAPID 1 study, the median DAS28 improvements 12 weeks after enrollment into the open-label study were similar in the dose-escalation and stable-dose groups. Individual patient-level data revealed no greater likelihood of response in the group of patients who received an increased dosage of CZP versus those in whom a stable dosage was maintained, whether they had completed the RAPID 1 study or had been withdrawn early.Conclusion. Although patient heterogeneity in clinical settings is acknowledged, the present results indicate that increasing the dose of CZP from 200 mg to 400 mg offers little additional benefit in RA, even for selected patients.

Cost and Effectiveness of Biologics for Rheumatoid Arthritis in a Commercially Insured Population

“…Dose escalation of anti-TNF agents has shown only limited effectiveness in the long-term control of RA (mainly for infliximab and less so for other biologics). 34,40,41 Similarly, approximately 15% of patients failed the criterion for increased corticosteroid doses, but in clinical practice, this may enable patients to achieve clinical endpoints without changing the dose of the biologic. Conversely, the low adherence criterion caused a substantial proportion of both SC and IV biologics to be classified as "not effective"; some patients may reduce the frequency of dosing or stop the medication when their symptoms improve (i.e., the medication is highly effective), yet the algorithm would categorize the biologic as "not effective."…”

Updated consensus statement on biological agents for the treatment of rheumatic diseases, 2012: Table 1

“…Likewise, no effect of increasing certolizumab dosing from 200 to 400 mg every 2 weeks has been shown (category D evidence301). The addition or substitution of other DMARDs may increase efficacy in some patients.…”

Persistence and Dose Escalation of Tumor Necrosis Factor Inhibitors in US Veterans with Rheumatoid Arthritis

“…While data from randomized clinical trials have provided some information on different doses of TNFi agents, only a few studies have evaluated the effect of dose escalation on clinical outcomes 6,20,21 . There is also significant cost associated with TNFi therapy, and the cost effectiveness of these agents has been challenging to evaluate 22,23,24,25,26 .…”