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Ultrasound may help identify RA patients suitable for step-down anti-TNF therapy
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Ultrasound, combined with clinical assessment, may be helpful for identifying patients with rheumatoid arthritis who are suitable candidates for a dose reduction of anti-tumor necrosis factor therapies, according to recently published research.
Researchers studied 70 patients with rheumatoid arthritis (RA) undergoing treatment at the University Hospital Southampton with anti-tumor necrosis factor (anti-TNF) therapy between January 2012 and February 2014. Patients had long disease duration and had failed prior treatments.
All patients were considered candidates for dose reduction after 6 months or more of disease activity score in 28 joints (DAS28) remission and no evidence of synovitis on power Doppler ultrasound (PDUS). The reduction strategy consisted of reducing the dose by one-third by increasing the time in between doses, with follow-up at 12 weeks and every 24 weeks thereafter.
Cross-sectional analysis showed 37 patients (54%) remained in sustained DAS28 and PDUS remission at a mean 10.2 months follow-up, whereas 32 patients (46%) had disease activity flare. Patients who sustained remission were more likely to have lower DAS28 at anti-TNF initiation and were more likely to not show positive rheumatoid factor, according to the researchers. No other associations were seen.
A review of individual case data showed that at 3 months of follow-up, 96% of patients remained in remission; 63% remained in remission at 6 months, 37% remained in remission at 9 months and 88% maintained at least low disease activity with DAS28 of less than 3.2 and PDUS of 1 or less at 6 months.
Of patients with disease flare, 41% had an increase in DAS28 only, 25% had synovitis present on PDUS only and 25% had both. The mean increase in DAS28 was 1.14 in patients who had disease flare, and only 34% of patients with flare activity would have been identified by DAS28 alone; however, about half of those patients showed synovitis developing on PDUS, according to the researchers. - by Shirley Pulawski
Disclosures: Marks received consulting and speaking fees and/or honoraria from AbbVie. Please see the full study for a list of all other authors’ relevant financial disclosures.
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