Low starting dosage of infliximab with possible escalating dosage in psoriatic arthritis gives the same treatment results as standard dosage of adalimumab or etanercept: results from the nationwide Icelandic ICEBIO registry

Abstract

Objective

To explore differences in response to a low dosage regimen of infliximab with an escalating dosage in comparison to a standard dosage of etanercept and adalimumab in patients with psoriatic arthritis (PsA).

Methods

Biologically naïve PsA patients who were beginning anti-TNF-α therapy were selected from the ICEBIO registry. Demographics and clinical differences were compared in four treatment groups: infliximab <4 mg/kg; infliximab >4 mg/kg; etanercept or adalimumab at baseline and on follow-up (6 and 12 months, last visit). The Kruskal–Wallis rank sum test was used for comparison of the groups and the Wilcoxon test to compare the two infliximab dosage regimens.

Results

One hundred and eighty-five patients (61% female) were identified; 84 patients received infliximab, 66 etanercept, and 35 adalimumab. A total of 19% of the patients treated with infliximab escalated their dosage ≥4 mg/kg. No significant differences were observed at baseline in respect to visual analog scale (VAS) pain, VAS fatigue, Health Assessment Questionnaire, C-reactive protein (CRP), numbers of swollen or tender joints, or Disease Activity Score (DAS) 28-CRP values. A similar treatment response was observed in all four treatment groups on follow-up.

Conclusion

In respect to treatment effects, a low dosage of infliximab with possible escalating dosage is acceptable for the majority of PsA patients who are in need of biological treatment.

Keywords:

• psoriatic arthritis
• outcome
• biological treatment
• routine care
• clinical nationwide registry

Acknowledgments

Thanks to Elinborg Stefansdottir, RN, for all practical help. Thanks to all those patients who record their symptoms on regular visits in ICEBIO, and to all rheumatologists in Iceland who are part of the ICEBIO group: Erlendsson K, Grondal G, Ingvarsson RF, Jonsson H, Jonsdottir T, Love TJ, Ludviksson BR, Reynisdottir GB, Steinsson K, Tomasson G, Valtysdottir S, and Vikingsson A. The study was partly funded by a study grant from The Icelandic Society for Rheumatology.

The study was presented as a poster (2227) at the ACR/ARHP Annual Meeting, November 9–14, 2012, Washington, DC, USA.

Disclosure

The authors report no conflicts of interest in this work.