Dose optimization of infliximab in patients with rheumatoid arthritis
Version of Record online: 1 NOV 2013
© 2013 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd
International Journal of Rheumatic Diseases
Volume 17, Issue 1, pages 5–18, January 2014
How to Cite
Alten, R. and van den Bosch, F. (2014), Dose optimization of infliximab in patients with rheumatoid arthritis. International Journal of Rheumatic Diseases, 17: 5–18. doi: 10.1111/1756-185X.12202
- Issue online: 28 JAN 2014
- Version of Record online: 1 NOV 2013
- TNF inhibitors;
- rheumatoid arthritis;
- dose optimization
It is well established that tumor necrosis factor (TNF) inhibitors help control disease activity, limit radiographic progression and preserve function in patients with rheumatoid arthritis. However, not all patients respond adequately to initial anti-TNF treatment and some patients lose response over time. Possible treatment modifications include optimizing concomitant disease-modifying antirheumatic drugs, switching to another anti-TNF biologic or another class of agent, or optimizing the dose of the anti-TNF agent. Here we review data on dose optimization of infliximab, with emphasis on dose changes to address inadequate response, nonresponse and loss of response.
The authors conducted a literature review to identify studies that evaluated the effect of dose optimization on clinical response in infliximab-treated patients with rheumatoid arthritis.
Few well-controlled studies of dose optimization of infliximab have been completed for patients with rheumatoid arthritis, and the evidence supporting efficacy and safety after dose adjustment can be difficult to interpret. Studies of dose optimization in infliximab-treated patients who fail to show initial response, have an inadequate response, or lose response over time are not entirely consistent, but tend to show a pattern of improvement after a dose increase.
Dose optimization involves a balance of risks and benefits, and future research should seek to clarify which patients are most likely to benefit from dose optimization without undue increase in risk.