Abstract
We reported the efficacy of dose escalation of infliximab (IFX) therapy in patients with rheumatoid arthritis (RA). However, the clinical course after escalation of IFX is unknown. This time, we report whether de-escalation of IFX is possible or not.
[Methods] Fifty patients (4 males and 46 females) treated with a high dose of IFX were examined. If the patients still remain in state of moderate disease activity, dose escalation of IFX is performed (3mg [8week [W]] -> 6mg [8W] -> 10mg [8W] or 6mg [4W]/kg). If the patients remain in remission, the dose de-escalation of IFX is performed (10mg [8W] or 6mg [4W] -> 6mg [8W] -> 3mg [8W]/kg). Moreover, when patients remain in remission for≧6 months at the dose of 3mg[8W]/kg of IFX and desired to discontinue IFX, IFX was discontinued.
[Results] The max dose of IFX was 6mg/kg in 12% and 10mg/kg in 88% of patients. At the time of the last observation, 20% of patients were given in dose of 10mg/kg [8W] or 6mg/kg [4W], 8% in 6mg/kg [8W] and 18% in 3mg/kg [8W] of IFX. Nine patients (18%) underwent discontinuation of IFX and 6 patients (12%) remained in remission over 1 year. Twenty-six percent of patients underwent discontinuation of IFX in mid-course, because of a number of some reasons (adverse effects; 8%, insufficiency; 16%, discontinuation of MTX; 8%, changing hospital; 2%, patient’s economical problem; 2%).
[Conclusion] The efficacy of dose escalation of IFX therapy in patients with RA is shown. Moreover, the doses of IFX could be de-escalated after escalation of IFX and cessation of IFX was successful in some cases.
