Dosing down with biologic therapies: a systematic review and clinicians’ perspective
Identifieur interne : 001840 ( Main/Exploration ); précédent : 001839; suivant : 001841Dosing down with biologic therapies: a systematic review and clinicians’ perspective
Auteurs : Christopher J. Edwards [Royaume-Uni] ; Bruno Fautrel [France] ; Hendrik Schulze-Koops [Allemagne] ; Tom W J. Huizinga [Pays-Bas] ; Klaus Kruger [Allemagne]Source :
- Rheumatology (Oxford, England) [ 1462-0324 ] ; 2017.
Abstract
The effectiveness of biologic therapies now means that remission or low disease activity are realistic targets for treatment. However, after achieving remission/low disease activity, the next steps remain unclear. The aim of this publication was to conduct a broad systematic literature review to evaluate dosing down of biologics. After screening papers and abstracts for relevance and application of inclusion/exclusion criteria, a structured extraction process was used to collect information on the included studies. Fifty-two papers were included in the analysis across rheumatic disease. In patients who discontinue therapy, remission is not typically sustained, with reported rates of relapse and flare across early RA (48–54%), established RA (2–84%), axial spondyloarthritis (11–53%) and PsA (44.9%). In many cases, an acceptable disease activity can be regained upon retreatment. More research is needed to understand the long-term impacts of these strategies on efficacy, safety and cost.
Url:
DOI: 10.1093/rheumatology/kew464
PubMed: 28339632
PubMed Central: 5850865
Affiliations:
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Edwards</name><affiliation wicri:level="1"><nlm:aff id="kew464-aff1">Musculoskeletal Research Unit, NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Musculoskeletal Research Unit, NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton</wicri:regionArea><wicri:noRegion>Southampton</wicri:noRegion></affiliation></author><author><name sortKey="Fautrel, Bruno" sort="Fautrel, Bruno" uniqKey="Fautrel B" first="Bruno" last="Fautrel">Bruno Fautrel</name><affiliation><nlm:aff id="kew464-aff2">Pierre et Marie Curie University – Paris 6, Sorbonne Universités, Pierre Louis Institute of Epidemiology and Public Health, Paris, GRC-08 (EEMOIS)</nlm:aff><wicri:noCountry code="subfield">GRC-08 (EEMOIS)</wicri:noCountry></affiliation><affiliation wicri:level="3"><nlm:aff id="kew464-aff3">APHP, Rheumatology Department, Pitié Salpêtrière Hospital, Paris, F-75013, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>APHP, Rheumatology Department, Pitié Salpêtrière Hospital, Paris, F-75013</wicri:regionArea><placeName><region type="region" nuts="2">Île-de-France</region></placeName></affiliation></author><author><name sortKey="Schulze Koops, Hendrik" sort="Schulze Koops, Hendrik" uniqKey="Schulze Koops H" first="Hendrik" last="Schulze-Koops">Hendrik Schulze-Koops</name><affiliation wicri:level="3"><nlm:aff id="kew464-aff4">Division of Rheumatology and Clinical Immunology, Department of Medicine IV, Ludwig-Maximilians-Universität, Munich, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Division of Rheumatology and Clinical Immunology, Department of Medicine IV, Ludwig-Maximilians-Universität, Munich</wicri:regionArea><placeName><region type="land" nuts="1">Bavière</region><region type="district" nuts="2">District de Haute-Bavière</region><settlement type="city">Munich</settlement></placeName></affiliation></author><author><name sortKey="Huizinga, Tom W J" sort="Huizinga, Tom W J" uniqKey="Huizinga T" first="Tom W J" last="Huizinga">Tom W J. Huizinga</name><affiliation wicri:level="1"><nlm:aff id="kew464-aff5">Department of Rheumatology, Leiden University Medical Center, Leiden, C1-41, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Rheumatology, Leiden University Medical Center, Leiden, C1-41</wicri:regionArea><wicri:noRegion>C1-41</wicri:noRegion></affiliation></author><author><name sortKey="Kruger, Klaus" sort="Kruger, Klaus" uniqKey="Kruger K" first="Klaus" last="Kruger">Klaus Kruger</name><affiliation wicri:level="3"><nlm:aff id="kew464-aff6">Rheumatologisches Schwerpunktzentrum, Munich, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Rheumatologisches Schwerpunktzentrum, Munich</wicri:regionArea><placeName><region type="land" nuts="1">Bavière</region><region type="district" nuts="2">District de Haute-Bavière</region><settlement type="city">Munich</settlement></placeName></affiliation></author></analytic><series><title level="j">Rheumatology (Oxford, England)</title><idno type="ISSN">1462-0324</idno><idno type="eISSN">1462-0332</idno><imprint><date when="2017">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><title>Abstract</title><p>The effectiveness of biologic therapies now means that remission or low disease activity are realistic targets for treatment. However, after achieving remission/low disease activity, the next steps remain unclear. The aim of this publication was to conduct a broad systematic literature review to evaluate dosing down of biologics. After screening papers and abstracts for relevance and application of inclusion/exclusion criteria, a structured extraction process was used to collect information on the included studies. Fifty-two papers were included in the analysis across rheumatic disease. In patients who discontinue therapy, remission is not typically sustained, with reported rates of relapse and flare across early RA (48–54%), established RA (2–84%), axial spondyloarthritis (11–53%) and PsA (44.9%). In many cases, an acceptable disease activity can be regained upon retreatment. More research is needed to understand the long-term impacts of these strategies on efficacy, safety and cost.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Smolen, Js" uniqKey="Smolen J">JS Smolen</name></author><author><name sortKey="Landewe, R" uniqKey="Landewe R">R Landewé</name></author><author><name sortKey="Breedveld, Fc" uniqKey="Breedveld F">FC Breedveld</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Gossec, L" uniqKey="Gossec L">L Gossec</name></author><author><name sortKey="Smolen, Js" uniqKey="Smolen J">JS Smolen</name></author><author><name sortKey="Gaujoux Viala, C" uniqKey="Gaujoux Viala C">C Gaujoux-Viala</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Braun, J" uniqKey="Braun J">J Braun</name></author><author><name sortKey="Van Den Berg, R" uniqKey="Van Den Berg R">R van den Berg</name></author><author><name sortKey="Baraliakos, X" uniqKey="Baraliakos X">X Baraliakos</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Smolen, Js" uniqKey="Smolen J">JS Smolen</name></author><author><name sortKey="Aletaha, D" uniqKey="Aletaha D">D Aletaha</name></author><author><name sortKey="Bijlsma, Jw" uniqKey="Bijlsma J">JW Bijlsma</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Smolen, Js" uniqKey="Smolen J">JS Smolen</name></author><author><name sortKey="Braun, J" uniqKey="Braun J">J Braun</name></author><author><name sortKey="Dougados, M" uniqKey="Dougados M">M Dougados</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Aga, Ab" uniqKey="Aga A">AB Aga</name></author><author><name sortKey="Lie, E" uniqKey="Lie E">E Lie</name></author><author><name sortKey="Uhlig, T" uniqKey="Uhlig T">T Uhlig</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bartlett, Sj" uniqKey="Bartlett S">SJ Bartlett</name></author><author><name sortKey="Hewlett, S" uniqKey="Hewlett S">S Hewlett</name></author><author><name sortKey="Bingham, Co" uniqKey="Bingham C">CO Bingham</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bykerk, Vp" uniqKey="Bykerk V">VP Bykerk</name></author><author><name sortKey="Shadick, N" uniqKey="Shadick N">N Shadick</name></author><author><name sortKey="Frits, M" uniqKey="Frits M">M Frits</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Den Broeder, Aa" uniqKey="Den Broeder A">AA den Broeder</name></author><author><name sortKey="Van Der Maas, A" uniqKey="Van Der Maas A">A van der Maas</name></author><author><name sortKey="Van Den Bemt, Bj" uniqKey="Van Den Bemt B">BJ. van den Bemt</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Den Broeder, Aa" uniqKey="Den Broeder A">AA den Broeder</name></author><author><name sortKey="Van Herwaarden, N" uniqKey="Van Herwaarden N">N van Herwaarden</name></author><author><name sortKey="Van Der Maas, A" uniqKey="Van Der Maas A">A van der Maas</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Van Herwaarden, N" uniqKey="Van Herwaarden N">N van Herwaarden</name></author><author><name sortKey="Den Broeder, Aa" uniqKey="Den Broeder A">AA den Broeder</name></author><author><name sortKey="Jacobs, W" uniqKey="Jacobs W">W Jacobs</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Higgins, Jp" uniqKey="Higgins J">JP Higgins</name></author><author><name sortKey="Altman, Dg" uniqKey="Altman D">DG Altman</name></author><author><name sortKey="G Tzsche, Pc" uniqKey="G Tzsche P">PC Gøtzsche</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Downs, Sh" uniqKey="Downs S">SH Downs</name></author><author><name sortKey="Black, N" uniqKey="Black N">N. 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Edwards</name></noRegion></country><country name="France"><region name="Île-de-France"><name sortKey="Fautrel, Bruno" sort="Fautrel, Bruno" uniqKey="Fautrel B" first="Bruno" last="Fautrel">Bruno Fautrel</name></region></country><country name="Allemagne"><region name="Bavière"><name sortKey="Schulze Koops, Hendrik" sort="Schulze Koops, Hendrik" uniqKey="Schulze Koops H" first="Hendrik" last="Schulze-Koops">Hendrik Schulze-Koops</name></region><name sortKey="Kruger, Klaus" sort="Kruger, Klaus" uniqKey="Kruger K" first="Klaus" last="Kruger">Klaus Kruger</name></country><country name="Pays-Bas"><noRegion><name sortKey="Huizinga, Tom W J" sort="Huizinga, Tom W J" uniqKey="Huizinga T" first="Tom W J" last="Huizinga">Tom W J. Huizinga</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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