The efficacy of treating according to a dose-escalation infliximab increasing protocol; the practice of Treat to Target (T2T) aimed at the low disease activity

DOI
  • Ootomo Kotaro
    Department of Internal Medicine II, Hokkaido University Graduate School of Medicine
  • Kurita Takashi
    Department of Internal Medicine II, Hokkaido University Graduate School of Medicine
  • Odani Toshio
    Department of Internal Medicine II, Hokkaido University Graduate School of Medicine
  • Fujieda Yuichiro
    Department of Internal Medicine II, Hokkaido University Graduate School of Medicine
  • Kato Masaru
    Department of Internal Medicine II, Hokkaido University Graduate School of Medicine
  • Kon Yujiro
    Department of Internal Medicine II, Hokkaido University Graduate School of Medicine
  • Oku Kenji
    Department of Internal Medicine II, Hokkaido University Graduate School of Medicine
  • Horita Tetsuya
    Department of Internal Medicine II, Hokkaido University Graduate School of Medicine
  • Yasuda Shinsuke
    Department of Internal Medicine II, Hokkaido University Graduate School of Medicine
  • Atsumi Tatsuya
    Department of Internal Medicine II, Hokkaido University Graduate School of Medicine

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Other Title
  • プロトコルに沿ったインフリキシマブ増量の有用性の検討 ―低疾患活動性を目指したT2Tの実践―

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Background: The validity and safety in high-dose infliximab (IFX) medication for patients with rheumatoid arthritis (RA) were shown by the RISING study. However, there are few reports using the dose-escalation IFX method according to disease activity.<br> Methods: We established a dose-escalation IFX protocol for RA, and have treated patients with RA according to this protocol since2009. The efficacy and safety were retrospectively compared with a historical control protocol with dose-fixed IFX.<br> Results: Nineteen patients were treated with the dose-escalation IFX protocol (dose-escalation group) and their outcomes were compared with those of 22historical controls treated with the dose-fixed IFX protocol (control group). No significant differences were found in the backgrounds between the groups. Since there were no early discontinuations due to poor response to IFX among the dose-escalation group, the rate of IFX continuation was increased in doseescalation group. The remission rates of the dose-escalation group, using the measures of DAS28＜2.6, SDAI≦3.3 and CDAI≦2.8, were significantly improved compared to those of control group (p＜0.05, chi-square test). The incidence rates of adverse events between these groups were not significantly different during the follow-up periods.<br> Conclusion: The dose-escalation IFX therapy was well tolerated for RA and contributed to better remission induction.

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