Dose titration using the Disease Activity Score (DAS28) in rheumatoid arthritis patients treated with anti-TNF-α
Dose titration using the Disease Activity Score (DAS28) in rheumatoid arthritis patients treated with anti-TNF-α
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DOI：
10.1093/rheumatology/41.6.638
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发表时间：
2002-06-01
期刊：
影响因子：
5.5
通讯作者：
van Riel, PLCM
中科院分区：
文献类型：
--
作者：
den Broeder, AA;Creemers, MCW;van Riel, PLCM
目标。在类风湿关节炎(RA)患者开始治疗后不久，抗肿瘤坏死因子-α(TNF-α)治疗就产生了很高的应答率，从理论上讲，患者之间的有效剂量可以预期会有很大的差异。再加上高昂的成本，这些差异需要新的方法来给患者服药。在一项持续40周的开放性扩展研究中，我们使用疾病活动评分(DAS28)，一个综合的疾病活动指数，来滴定21名疾病活动较低的患者的抗肿瘤坏死因子-α(阿达利单抗，D2E7；Knoll)的剂量。抗肿瘤坏死因子-α的剂量逐步减少，给药间隔保持稳定。疾病活动性和耀斑使用DAS28进行评估。红肿患者接受先前的有效剂量。15例患者完成了减量治疗。给予患者的抗肿瘤坏死因子-α总量减少了67%。在研究结束时，DAS28的平均值没有改变，没有患者因RA的持续恶化而退出。使用DAS28进行抗肿瘤坏死因子-α治疗的剂量滴定是可行的，并在保持临床疗效的同时导致总体剂量减少。这种方法将节省成本，并可能防止长期副作用。
Objective. Anti-tumour necrosis factor alpha (TNF-alpha) therapy yields high response rates shortly after institution of therapy in patients with rheumatoid arthritis (RA), and on theoretical grounds large differences in the effective dose between patients can be expected. Together with the high costs, these differences warrant new approaches to the way patients are dosed.Methods. We used the Disease Activity Score (DAS28), a composite disease activity index, to titrate the dose of anti-TNF-alpha (adalimumab, D2E7; Knoll) in 21 patients with low disease activity in an open extension study lasting 40 weeks. The dose of anti-TNF-alpha was reduced stepwise and dosing intervals were kept stable. Disease activity and flares were assessed using the DAS28. Patients who flared received the previous effective dose.Results. Dose reduction was accomplished in 15 patients. The total amount of anti-TNF-alpha given to the patients was reduced by 67%. At the end of the study the mean DAS28 had not changed and no patients dropped out because of persistent worsening of the RA.Conclusion. Dose titration of anti-TNF-alpha treatment using the DAS28 is feasible and leads to overall dose reduction while maintaining clinical efficacy. This approach will save costs and possibly prevent long-term side-effects.