TY - JOUR
T1 - Impact of different infliximab dose regimens on treatment response and drug survival in 462 patients with psoriatic arthritis
T2 - results from the nationwide registries DANBIO and ICEBIO
AU - Glintborg, Bente
AU - Gudbjornsson, Bjorn
AU - Krogh, Niels Steen
AU - Omerovic, Emina
AU - Manilo, Natalia
AU - Holland-Fischer, Mette
AU - Lindegaard, Hanne M
AU - Loft, Anne Gitte
AU - Nordin, Henrik
AU - Johnsen, Laura
AU - Oeftiger, Sussi Flejsborg
AU - Hansen, Annette
AU - Rasmussen, Claus
AU - Grondal, Gerdur
AU - Geirsson, Arni Jon
AU - Hetland, Merete Lund
N1 - © The Author 2014. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: [email protected].
PY - 2014/7/28
Y1 - 2014/7/28
N2 - Objective. The aim of this study was to describe dose regimens, dose escalation and clinical outcomes in TNF-a inhibitor (TNFi)-naive patients with PsA treated with infliximab in routine rheumatology care. Methods. We conducted an observational cohort study based on the nationwide Danish Rheumatologic Database (DANBIO) and Center for Rheumatology Research (ICEBIO) registries. Stratified by country, characteristics of patients treated with ≤3mg infliximab/kg body weight, 3-5 mg/kg or ≥5 mg/kg every 8 weeks were described. Outcomes were evaluated by ACR 20%, 50% and 70% (ACR20/50/70) responses and European League Against Rheumatism good response after 6 months, disease activity after 12 months, Kaplan-Meier plots and regression analyses. Results. Four hundred and sixty-two patients (376 Danish, 86 Icelandic) received treatment with infliximab. In Danish patients, the starting dose was ≤3mg/kg in 110 patients (29%), 3-5mg/kg in 157 (42%), ≥5mg/ kg in 38 (10%) and unregistered in 71 (19%). In Icelandic patients, corresponding numbers were 64 (74%), 17 (27%), 0 (0%) and 5 (6%). Patients with a higher body weight received lower doses per kilogram. Danish patients received higher doses than Icelandic patients at baseline [median 3.1 (interquartile range 3.0-3.8) vs 2.3 (2.1-2.9) mg/kg, P<0.05] and after 12 months [3.3 (3.0-4.5) vs 2.9 (2.2-3.5) mg/kg, P<0.0001]. After 12 months, 58% of Danish and 66% of Icelandic patients maintained treatment. Danish patients had shorter drug survival than Icelandic patients (1183 vs 483 days). In univariate analyses stratified by country, time until dose escalation, response rates, drug survival and 1-year's disease activity were independent of starting dose. Drug survival was shorter among patients not receiving concomitant MTX. Conclusion. In clinical practice,>70% of Icelandic and Danish PsA patients treated with infliximab received sustained doses below the 5 mg/kg every 8 weeks recommended in international guidelines. Lower starting doses did not affect drug survival or response.
AB - Objective. The aim of this study was to describe dose regimens, dose escalation and clinical outcomes in TNF-a inhibitor (TNFi)-naive patients with PsA treated with infliximab in routine rheumatology care. Methods. We conducted an observational cohort study based on the nationwide Danish Rheumatologic Database (DANBIO) and Center for Rheumatology Research (ICEBIO) registries. Stratified by country, characteristics of patients treated with ≤3mg infliximab/kg body weight, 3-5 mg/kg or ≥5 mg/kg every 8 weeks were described. Outcomes were evaluated by ACR 20%, 50% and 70% (ACR20/50/70) responses and European League Against Rheumatism good response after 6 months, disease activity after 12 months, Kaplan-Meier plots and regression analyses. Results. Four hundred and sixty-two patients (376 Danish, 86 Icelandic) received treatment with infliximab. In Danish patients, the starting dose was ≤3mg/kg in 110 patients (29%), 3-5mg/kg in 157 (42%), ≥5mg/ kg in 38 (10%) and unregistered in 71 (19%). In Icelandic patients, corresponding numbers were 64 (74%), 17 (27%), 0 (0%) and 5 (6%). Patients with a higher body weight received lower doses per kilogram. Danish patients received higher doses than Icelandic patients at baseline [median 3.1 (interquartile range 3.0-3.8) vs 2.3 (2.1-2.9) mg/kg, P<0.05] and after 12 months [3.3 (3.0-4.5) vs 2.9 (2.2-3.5) mg/kg, P<0.0001]. After 12 months, 58% of Danish and 66% of Icelandic patients maintained treatment. Danish patients had shorter drug survival than Icelandic patients (1183 vs 483 days). In univariate analyses stratified by country, time until dose escalation, response rates, drug survival and 1-year's disease activity were independent of starting dose. Drug survival was shorter among patients not receiving concomitant MTX. Conclusion. In clinical practice,>70% of Icelandic and Danish PsA patients treated with infliximab received sustained doses below the 5 mg/kg every 8 weeks recommended in international guidelines. Lower starting doses did not affect drug survival or response.
KW - Adult
KW - Antibodies, Monoclonal
KW - Antirheumatic Agents
KW - Arthritis, Psoriatic
KW - Dose-Response Relationship, Drug
KW - Female
KW - Follow-Up Studies
KW - Humans
KW - Infusions, Intravenous
KW - Male
KW - Middle Aged
KW - Prospective Studies
KW - Registries
KW - Treatment Outcome
KW - Tumor Necrosis Factor-alpha
U2 - 10.1093/rheumatology/keu252
DO - 10.1093/rheumatology/keu252
M3 - Journal article
C2 - 24939677
SN - 1462-0324
VL - 53
SP - 2100
EP - 2109
JO - Rheumatology
JF - Rheumatology
IS - 11
ER -