Loredo Marta, Pardo Estefanía, Braña Ignacio, Burger Stefanie, Chiminazzo Valentina, Queiro Rubén
Rheumatology Division, Central University Hospital of Asturias, 33011 Oviedo, Spain.
Biostatistics Platform, Health Research Institute of the Principality of Asturias (ISPA), 33011 Oviedo, Spain.
J Clin Med. 2025 Jun 10;14(12):4099. doi: 10.3390/jcm14124099.
Dose tapering in patients with psoriatic arthritis (PsA) who achieve sustained treatment targets is a common but underexplored strategy, particularly in those receiving TNFα inhibitor biosimilars (TNFibs). This study aimed to assess the prevalence of dose optimization and identify factors associated with its implementation in clinical practice. We systematically selected 130 PsA patients with sustained treatment response from a database of individuals treated with advanced therapies. We evaluated the prevalence of dose optimization (defined as sustained dose reduction) and explored associated factors using multivariate logistic regression models. Of the 130 patients, 95 were receiving TNF inhibitors and 35 other advanced therapies. Among those on TNFis, 88 (93%) were treated with TNFibs. A total of 32 patients (24.6%) were undergoing dose optimization, including 30 from the TNFi group ( = 0.002). We found that 7 of the 88 patients on TNFibs (8%) experienced loss of therapeutic response during follow-up. One in three patients on TNFis underwent dose tapering. Factors independently associated with dose reduction included no history of tobacco exposure [OR 3.98, 95%CI: 1.3-14.2; = 0.021], male sex [OR 3.26, 95%CI: 1.26-9.04; = 0.018] and use of TNFis as first-line advanced therapy [OR 4.8, 95%CI: 1.7-16.7; = 0.003]. Approximately one in four PsA patients who achieve sustained treatment targets undergo dose optimization, most commonly with TNFibs. This strategy appears to be more feasible in male patients, non-smokers and those treated with TNFis as a first-line option.
在达到持续治疗目标的银屑病关节炎（PsA）患者中逐渐减少剂量是一种常见但未充分探索的策略，尤其是在接受肿瘤坏死因子α抑制剂生物类似药（TNFibs）治疗的患者中。本研究旨在评估剂量优化的发生率，并确定临床实践中与其实施相关的因素。我们从接受先进疗法治疗的个体数据库中系统地选取了130例具有持续治疗反应的PsA患者。我们评估了剂量优化（定义为持续减少剂量）的发生率，并使用多变量逻辑回归模型探索相关因素。在这130例患者中，95例接受肿瘤坏死因子抑制剂治疗，35例接受其他先进疗法。在接受肿瘤坏死因子抑制剂治疗的患者中，88例（93%）接受TNFibs治疗。共有32例患者（24.6%）正在进行剂量优化，其中30例来自肿瘤坏死因子抑制剂组（P = 0.002）。我们发现，88例接受TNFibs治疗的患者中有7例（8%）在随访期间出现治疗反应丧失。接受肿瘤坏死因子抑制剂治疗的患者中有三分之一进行了剂量逐渐减少。与剂量减少独立相关的因素包括无烟草接触史[比值比（OR）3.98，95%置信区间（CI）：1.3 - 14.2；P = 0.021]、男性[OR 3.26，95%CI：1.26 - 9.04；P = 0.018]以及将肿瘤坏死因子抑制剂作为一线先进疗法使用[OR 4.8，95%CI：1.7 - 16.7；P = 0.003]。在达到持续治疗目标的PsA患者中，约四分之一的患者进行剂量优化，最常见的是使用TNFibs。这种策略在男性患者、不吸烟者以及将肿瘤坏死因子抑制剂作为一线选择进行治疗的患者中似乎更可行。
