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Are there dangers in biologic dose reduction strategies?

Are there dangers in biologic dose reduction strategies?
Are there dangers in biologic dose reduction strategies?
Biologic dose reduction strategies, for patients with inflammatory rheumatic diseases, have been assessed in multiple studies to assess outcomes compared to ongoing maintenance dosing. Whilst cessation in established disease usually leads to disease flare, dose tapering approaches for those achieving low disease activity often appear to be successful in the short term. However, tapering can be associated with a higher risk of losing disease control and rates of recapture of disease control using the original biologic dose vary between studies.

Over relatively short periods of follow-up, a number of studies have shown no statistical difference in radiographic progression in patients tapering or discontinuing biologics. However, a Cochrane review found that radiographic and functional outcomes may be worse after TNF inhibitor discontinuation, and over long-term disease follow-up flares have been associated with radiographic progression and worse patient reported outcomes. To date, no studies of biological therapy dose reduction have specifically investigated the risk of increased immunogenicity or the effects on cardiovascular risk and other co-morbidities, although these remain important potential risks. In addition, whether there are greater dangers in certain dose reduction approaches such as a reduction in dose at the same frequency or a spacing of doses is not established.
biologic, dose, reduction, taper, risk
1568-9972
1-5
Chan, C.K.
aa92ce72-0c37-4bd5-adbe-aa43be289663
Holroyd, C.R.
bd50c028-34f5-493c-86da-eeb5f7ea9e78
Mason, A.
0cfc2ff4-70c2-4d1e-ad12-6b90ffe60b3f
Zarroug, J.
1dd887e5-9903-4595-9706-d9c9f2795b6f
Edwards, C.J.
dcb27fec-75ea-4575-a844-3588bcf14106
Chan, C.K.
aa92ce72-0c37-4bd5-adbe-aa43be289663
Holroyd, C.R.
bd50c028-34f5-493c-86da-eeb5f7ea9e78
Mason, A.
0cfc2ff4-70c2-4d1e-ad12-6b90ffe60b3f
Zarroug, J.
1dd887e5-9903-4595-9706-d9c9f2795b6f
Edwards, C.J.
dcb27fec-75ea-4575-a844-3588bcf14106

Chan, C.K., Holroyd, C.R., Mason, A., Zarroug, J. and Edwards, C.J. (2016) Are there dangers in biologic dose reduction strategies? Autoimmunity Reviews, 1-5. (doi:10.1016/j.autrev.2016.03.013). (PMID:26970488)

Record type: Article

Abstract

Biologic dose reduction strategies, for patients with inflammatory rheumatic diseases, have been assessed in multiple studies to assess outcomes compared to ongoing maintenance dosing. Whilst cessation in established disease usually leads to disease flare, dose tapering approaches for those achieving low disease activity often appear to be successful in the short term. However, tapering can be associated with a higher risk of losing disease control and rates of recapture of disease control using the original biologic dose vary between studies.

Over relatively short periods of follow-up, a number of studies have shown no statistical difference in radiographic progression in patients tapering or discontinuing biologics. However, a Cochrane review found that radiographic and functional outcomes may be worse after TNF inhibitor discontinuation, and over long-term disease follow-up flares have been associated with radiographic progression and worse patient reported outcomes. To date, no studies of biological therapy dose reduction have specifically investigated the risk of increased immunogenicity or the effects on cardiovascular risk and other co-morbidities, although these remain important potential risks. In addition, whether there are greater dangers in certain dose reduction approaches such as a reduction in dose at the same frequency or a spacing of doses is not established.

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More information

Accepted/In Press date: 4 March 2016
Published date: 10 March 2016
Keywords: biologic, dose, reduction, taper, risk
Organisations: Faculty of Medicine

Identifiers

Local EPrints ID: 390544
URI: https://eprints.soton.ac.uk/id/eprint/390544
ISSN: 1568-9972
PURE UUID: 8ce755f5-1a7e-4239-99a2-210da3b696a4

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Date deposited: 04 Apr 2016 10:50
Last modified: 15 Jul 2019 20:39

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Contributors

Author: C.K. Chan
Author: C.R. Holroyd
Author: A. Mason
Author: J. Zarroug
Author: C.J. Edwards

University divisions

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