Document Detail

Dose escalation of the anti-TNF-alpha agents in patients with rheumatoid arthritis. A systematic review.
MedLine Citation:
PMID:  17012439     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To estimate the proportion of rheumatoid arthritis (RA) patients on anti-tumour necrosis factor (anti-TNF) who require dose escalation.
METHODS: Systematic review of the scientific literature. Infliximab, etanercept and adalimumab studies in RA were considered. Primary outcome was the proportion of patients requiring dose escalation. American College Rheumatology (ACR) and Disease activity score (DAS) responses post-escalation were assessed when available.
RESULTS: From 1801 references, 16 studies with 8510 patients were included. Of all the infliximab patients, 53.7% underwent dose escalation. Fourty-four per cent of the infliximab patients experienced dose increase and 8.3%, frequency increase. The ACR20 response to dose escalation ranged from 27 to 36% and DAS28 improved from 5.2 to 4.5 in one study and from 4.1 to 3.7 in another. Of the etanercept patients, 17.5% experienced a dose increase but changes on the mean dose were not statistically significant.
CONCLUSIONS: Dose escalation is common in patients treated with infliximab, and less frequent with etanercept. In a proportion of patients, the dose escalation seems effective. The design and evidence level of the available studies limit the strength of the conclusions.
R Ariza-Ariza; F Navarro-Sarabia; B Hernández-Cruz; L Rodríguez-Arboleya; V Navarro-Compán; J Toyos
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review     Date:  2006-09-29
Journal Detail:
Title:  Rheumatology (Oxford, England)     Volume:  46     ISSN:  1462-0324     ISO Abbreviation:  Rheumatology (Oxford)     Publication Date:  2007 Mar 
Date Detail:
Created Date:  2007-02-19     Completed Date:  2007-05-09     Revised Date:  2013-05-27    
Medline Journal Info:
Nlm Unique ID:  100883501     Medline TA:  Rheumatology (Oxford)     Country:  England    
Other Details:
Languages:  eng     Pagination:  529-32     Citation Subset:  AIM; IM    
Rheumatology Service, Hospital Universitário Virgen Macarena, Seville, Spain.
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MeSH Terms
Antibodies, Monoclonal / administration & dosage
Antibodies, Monoclonal, Humanized
Antirheumatic Agents / administration & dosage*
Arthritis, Rheumatoid / drug therapy*
Drug Administration Schedule
Immunoglobulin G / administration & dosage
Immunologic Factors / administration & dosage*
Receptors, Tumor Necrosis Factor / administration & dosage
Treatment Outcome
Tumor Necrosis Factor-alpha / antagonists & inhibitors*
Reg. No./Substance:
0/Antibodies, Monoclonal; 0/Antibodies, Monoclonal, Humanized; 0/Antirheumatic Agents; 0/Immunoglobulin G; 0/Immunologic Factors; 0/Receptors, Tumor Necrosis Factor; 0/Tumor Necrosis Factor-alpha; 0/infliximab; 185243-69-0/TNFR-Fc fusion protein; FYS6T7F842/adalimumab

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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