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Comparison between full and tapered dosages of biologic therapies in psoriatic arthritis patients: clinical and ultrasound assessment

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Abstract

The primary objective of this study was to describe and compare clinical and musculoskeletal (MS) ultrasound (US) features between psoriatic arthritis (PsA) patients treated with full and tapered dosage of biologic (b) disease-modified antirheumatic drugs (DMARDs). The secondary objective was to compare clinical and MSUS features between PsA patients treated with bDMARDs with and without concomitant synthetic (s) DMARDs. We evaluated 102 patients with PsA treated with bDMARDs. The bDMARD dosage tapering had been made in patients with a maintained remission or minimal disease activity (MDA) according to their attending rheumatologist and with the patient acceptance. The bDMARD tapering consisted of the following: increase the interval between doses for subcutaneous bDMARDs or reduction of the dose for intravenous bDMARDs. The clinical evaluation consisted of a dermatologic and rheumatologic assessment of disease activity. The presence of B-mode and Doppler synovitis, tenosynovitis, enthesopathy, and paratenonitis was investigated by a rheumatologist blinded to drug dosage, clinical assessments, and laboratory results. Seventy-four (72.5 %) patients received full dosage of bDMARDs and 28 (27.5 %) received tapered dosage. The duration with biologic therapy and with current biologic therapy was significantly higher in patients with tapered dosages (p = 0.008 and p = 0.001, respectively). We found no significant differences between clinical, laboratory, and US variables, both for BM and CD between patients with full and tapered dosage and between patients with and without concomitant sDMARD. Clinical assessment, MSUS variables, and MDA status are similar in patients receiving full and tapered dosage of bDMARDs.

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References

  1. Langley RG, Krueger GG, Griffiths CE (2005) Psoriasis: epidemiology, clinical features, and quality of life. Ann Rheum Dis 64(Suppl.2):ii18–23 [discussion ii4–5]

  2. Gladman DD, Antoni C, Mease P, Clegg DO, Nash P (2005) Psoriatic arthritis: epidemiology, clinical features, course, and outcome. Ann Rheum Dis 64(Suppl II):ii14–ii17

    PubMed Central  PubMed  Google Scholar 

  3. Gossec L, Smolen JS, Gaujoux-Viala C et al (2012) European League Against Rheumatism. European League Against Rheumatism recommendations for the management of psoriatic arthritis with pharmacological therapies. Ann Rheum Dis 71(1):4–12

    Article  CAS  PubMed  Google Scholar 

  4. Smolen JS, Breedveld FC, Eberl G et al (1995) Validity and reliability of the twenty-eight-joint count for the assessment of rheumatoid arthritis activity. Arthritis Rheum 38:38–43

    Article  CAS  PubMed  Google Scholar 

  5. Garrett S, Jenkinson T, Kennedy LG, Whitelock H, Gaisford P, Calin A (1994) A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol 21(12):2286–2291

    CAS  PubMed  Google Scholar 

  6. Calin A, Garrett S, Whitelock H et al (1994) A new approach to defining functional ability in ankylosing spondylitis: the development of the Bath Ankylosing Spondylitis Functional Index. J Rheumatol 21(12):2281–2285

    CAS  PubMed  Google Scholar 

  7. Schoels M, Aletaha D, Funovits J, Kavanaugh A, Baker D, Smolen JS (2010) Application of the DAREA/DAPSA score for assessment of disease activity in psoriatic arthritis. Ann Rheum Dis 69(8):1441–1447

    Article  PubMed  Google Scholar 

  8. Mumtaz A, Gallagher P, Kirby B et al (2011) Development of a preliminary composite disease activity index in psoriatic arthritis. Ann Rheum Dis 70(2):272–7

    Article  PubMed  Google Scholar 

  9. Coates LC, Fransen J, Helliwell PS (2010) Defining minimal disease activity in psoriatic arthritis: a proposed target for treatment. Ann Rheum Dis 69:48–53

    Article  CAS  PubMed  Google Scholar 

  10. Coates LC, Helliwell PS (2010) Validation of minimal disease activity criteria for psoriatic arthritis using interventional trial data. Arthritis Care Res 62:965–969

    Article  Google Scholar 

  11. Saad AA, Ashcroft DM, Watson KD, Symmons DP, Noyce PR, Hyrich KL (2010) BSRBR. Efficacy and safety of anti-TNF therapies in psoriatic arthritis: an observational study from the British Society for Rheumatology Biologics Register. Rheumatology (Oxford) 49(4):697–705

    Article  CAS  Google Scholar 

  12. Heiberg MS, Kaufmann C, Rødevand E et al (2007) The comparative effectiveness of anti-TNF therapy and Methotrexate in patients with psoriatic arthritis: 6 months results from a longitudinal, observational, multicentre study. Ann Rheum Dis 66(8):1038–1042

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  13. Saber TP, Ng CT, Renard G et al (2010) Remission in psoriatic arthritis: is it possible and how can it be predicted? Arthritis Res Ther 12(3):R94

    Article  PubMed Central  PubMed  Google Scholar 

  14. Husic R, Gretler J, Felber A et al (2013) Disparity between ultrasound and clinical findings in psoriatic arthritis. Ann Rheum Dis. doi:10.1136/annrheumdis-2012-203073, published on 5 June

    Google Scholar 

  15. Smolen JS, Landewé R, Breedveld FC et al (2014) EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update. Ann Rheum Dis 73(3):492–509

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  16. Backhaus M, Kamradt T, Sandrock D et al (1999) Arthritis of the finger joints: a comprehensive approach comparing conventional radiography, scintigraphy, ultrasound, and contrast-enhanced magnetic resonance imaging. Arthritis Rheum 42:1232–1245

    Article  CAS  PubMed  Google Scholar 

  17. Galluzco E, Lischi DM, Taglione E et al (2000) Sonographic analysis of the ankle in patients with psoriatic arthritis. Scand J Rheumatol 29:52–55

    Article  Google Scholar 

  18. Balint PV, Kane D, Wilson H, Mclnnes IB, Sturrock RD (2002) Ultrasonography of entheseal insertions in the lower limb in spondyloarthropathy. Ann Rheum Dis 61:905–910

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  19. D’Agostino MA, Said-Nahal R, Hacquard-Bouder C, Brasseur JL, Dougados M, Breban M (2003) Assessment of peripheral enthesitis in the spondylarthropathies by ultrasonography combined with power Doppler. Arthritis Rheum 48:523–533

    Article  PubMed  Google Scholar 

  20. Kane D, Balint PV, Sturrock RD (2003) Ultrasonography is superior to clinical examination in the detection and localization of knee joint effusion in rheumatoid arthritis. J Rheumatol 30:966–971

    PubMed  Google Scholar 

  21. Wakefield RJ, Green MJ, Marzo-Ortega H et al (2004) Should oligoarthritis be reclassified? Ultrasound reveals a high prevalence of subclinical disease. Ann Rheum Dis 63:382–385

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  22. Szkudlarek M, Narvestad E, Klarlund M, Court-Payen M, Thomsen HS, Østergaard M (2004) Ultrasonography of the metatarsophalangeal joints in rheumatoid arthritis: comparison with magnetic resonance imaging, conventional radiography, and clinical examination. Arthritis Rheum 50:2103–2112

    Article  PubMed  Google Scholar 

  23. Naredo E, Bonilla G, Gamero F, Uson J, Carmona L, Laffon A (2005) Assessment of inflammatory activity in rheumatoid arthritis: a comparative study of clinical evaluation with grey scale and power Doppler ultrasonography. Ann Rheum Dis 64:375–381

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  24. Alcalde M, Acebes JC, Cruz M, Gonzalez-Hombrado L, Herrero-Beaumont G, Sanchez-Pernaute O (2007) A sonographic enthesitis index (SEI) of lower limbs is a valuable tool in the assessment of ankylosing spondylitis. Ann Rheum Dis 66:1015–1019

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  25. Szkudlarek M, Court-Payen M, Strandberg C, Klarlund M, Klausen T, Østergaard M (2001) Power Doppler ultrasonography for assessment of synovitis in the metacarpophalangeal joints of patients with rheumatoid arthritis: a comparison with dynamic magnetic resonance imaging. Arthritis Rheum 44:2018–2023

    Article  CAS  PubMed  Google Scholar 

  26. Naredo E, Möller I, Cruz A, Carmona L, Garrido J (2008) Power Doppler ultrasound monitoring of response to anti-tumor necrosis factor therapy in patients with rheumatoid Arthritis. Arthritis Rheum 58:2248–2256

    Article  PubMed  Google Scholar 

  27. Andersen M, Ellegaard K, Hebsgaard JB et al (2014) Ultrasound colour Doppler is associated with synovial pathology in biopsies from hand joints in rheumatoid arthritis patients: a cross-sectional study. Ann Rheum Dis 73(4):678–683

    Article  PubMed  Google Scholar 

  28. Taylor W, Gladman D, Helliwell P, Marchesoni A, Mease P, Mielants H, the CASPAR Study Group (2006) Classification criteria for psoriatic arthritis development of new criteria from a large international study. Arthritis Rheum 54:2665–2673

    Article  PubMed  Google Scholar 

  29. Fernandez Sueiro JL, Juanola Roura X, de Dios Canete Crespillo J et al (2011) Consensus statement of the Spanish Society of Rheumatology on the management of biologic therapies in psoriatic arthritis. Reumatol Clin 7(3):179–188

    Article  PubMed  Google Scholar 

  30. Fredriksson T, Pettersson U (1978) Severe psoriasis-oral therapy with a new retinoid. Dermatologica 157(4):238–244

    Article  CAS  PubMed  Google Scholar 

  31. Heuft-Dorenbosch L, Spoorenberg A, van Tubergen A et al (2003) Assessment of enthesitis in ankylosing spondylitis. Ann Rheum Dis 62:127–132

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  32. Rudwaleit M, van der Heijde D, Landewé R et al (2011) The Assessment of SpondyloArthritis International Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general. Ann Rheum Dis 70(1):25–31

    Article  CAS  PubMed  Google Scholar 

  33. Rudwaleit M, van der Heijde D, Landewé R et al (2009) The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis 68(6):777–783

    Article  CAS  PubMed  Google Scholar 

  34. Naredo E, D'Agostino MA, Wakefield RJ et al (2013) OMERACT Ultrasound Task Force. Reliability of a consensus-based ultrasound score for tenosynovitis in rheumatoid arthritis. Ann Rheum Dis 72(8):1328–1334

    Article  PubMed  Google Scholar 

  35. Wakefield RJ, Balint PV, Szkudlarek M et al (2005) OMERACT 7 Special Interest Group. Musculoskeletal ultrasound including definitions for ultrasonographic pathology. J Rheumatol 32(12):2485–2487

    PubMed  Google Scholar 

  36. Szkudlarek M, Court-Payen M, Jacobsen S, Klarlund M, Thomsen HS, Østergaard M (2003) Interobserver agreement in ultrasonography of the finger and toe joints in rheumatoid arthritis. Arthritis Rheum 48(4):955–962

    Article  PubMed  Google Scholar 

  37. Saleem B, Keen H, Goeb V et al (2010) Patients with RA in remission on TNF blockers: when and in whom can TNF blocker therapy be stopped? Ann Rheum Dis 69:1636–1642

    Article  PubMed  Google Scholar 

  38. Klarenbeek NB, van der Kooij SM, Güler-Yüksel M et al (2011) Discontinuing treatment in patients with rheumatoid arthritis in sustained clinical remission: exploratory analyses from the BeSt study. Ann Rheum Dis 70:315–319

    Article  CAS  PubMed  Google Scholar 

  39. van der Maas A, Kievit W, van den Bemt BJ, van den Hoogen FH, van Riel PL, den Broeder AA (2012) Down-titration and discontinuation of infliximab in rheumatoid arthritis patients with stable low diseaseactivity and stable treatment: an observational cohort study. Ann Rheum Dis 71:1849–1854

    Article  PubMed  Google Scholar 

  40. Cantini F, Niccoli L, Cassarà E, Kaloudi O, Nannini C (2012) Sustained maintenance of clinical remission after adalimumab dose reduction in patients with early psoriatic arthritis: a long-term follow-up study. Biologics 6:201–206

    PubMed Central  CAS  PubMed  Google Scholar 

  41. Araujo EG, Finzel S, Englbrecht M et al (2013) High incidence of disease recurrence after discontinuation of disease-modifying antirheumatic drug treatment in patients with psoriatic arthritis in remission. Ann Rheum Dis. doi:10.1136/annrheumdis-2013-204229

    Google Scholar 

  42. Freeston JE, Coates LC, Nam JL et al (2014) Is there subclinical synovitis in early psoriatic arthritis? A clinical comparison with gray-scale and power Doppler ultrasound. Arthritis Care Res (Hoboken) 66(3):432–439

    Article  Google Scholar 

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Author contributions

Iustina Janta, Lina Martínez-Estupiñán, Esperanza Naredo, and Lara Valor did the study design. Iustina Janta, Lina Martínez-Estupiñán, Lara Valor, Esperanza Naredo, Ofelia Baniandres Rodriguez, Ignacio Hernández Aragüés, María Montoro, Natalia Bello, Diana Hernández-Flórez, Michelle Hinojosa, Julia Martínez-Barrio, Juan Carlos Nieto-González, Juan Gabriel Ovalles-Bonilla, Carlos Manuel González, Francisco Javier López-Longo, and Indalecio Monteagudo performed the acquisition of data. Iustina Janta, Lina Martínez-Estupiñán, Esperanza Naredo, Lara Valor, and Luis Carreño Analyzed and interpreted the data. Iustina Janta, Lina Martínez-Estupiñán, Esperanza Naredo, Lara Valor, and Luis Carreño prepared the manuscript.

Conflict of interest

Esperanza Naredo has received speaker fees from Abbvie, Roche Farma, Bristol-Myers Squibb, Pfizer, UCB, General Electric Healthcare, and Esaote. Esperanza Naredo has received research funding from UCB and MSD. Indalecio Monteagudo has received speaker fees from Abbvie, Roche Farma, Bristol-Myers Squibb, Pfizer, and UCB. Juan Carlos Nieto-González has received speaker fees from Abbvie, Roche Farma, Pfizer, and MSD. Francisco Javier López Longo has received speaker fees from Abbvie, Roche Farma, Bristol-Myers Squibb, Pfizer, UCB, MSD, and Actelion. Francisco Javier López Longo has received research funding from Abbvie and GSK. Lara Valor has received speaker fees from Abbvie, Roche Farma, Bristol-Myers Squibb, and Pfizer.

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Authors and Affiliations

  1. Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain

    Iustina Janta, Lina Martínez-Estupiñán, Lara Valor, María Montoro, Natalia Bello, Diana Hernández-Flórez, Michelle Hinojosa, Julia Martínez-Barrio, Juan Carlos Nieto-González, Juan Gabriel Ovalles-Bonilla, Carlos Manuel González, Francisco Javier López-Longo, Indalecio Monteagudo, Esperanza Naredo & Luis Carreño

  2. Department of Dermatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain

    Ofelia Baniandres Rodriguez & Ignacio Hernández Aragüés

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  1. Iustina Janta
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  2. Lina Martínez-Estupiñán
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  11. Juan Carlos Nieto-González
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  14. Francisco Javier López-Longo
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  15. Indalecio Monteagudo
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Correspondence to Iustina Janta.

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Janta, I., Martínez-Estupiñán, L., Valor, L. et al. Comparison between full and tapered dosages of biologic therapies in psoriatic arthritis patients: clinical and ultrasound assessment. Clin Rheumatol 34, 935–942 (2015). https://doi.org/10.1007/s10067-015-2880-7

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