SHORT COMMUNICATION Observational study of optimization of biologic therapies in rheumatoid arthritis: a single-centre experience Jose Ramon Maneiro • Eva Perez-Pampin • Eva Salgado • Loreto Carmona • Juan J. Gomez-Reino Received: 26 April 2013 / Accepted: 16 July 2013 / Published online: 28 July 2013 Ó Springer-Verlag Berlin Heidelberg 2013 Abstract To analyse the effectiveness of optimization of biologics in rheumatoid arthritis (RA). It was a single- centre retrospective observational study from January 2009 to September 2012. The effectiveness of the optimization of TNF antagonists, tocilizumab and abatacept in RA was studied. Optimization included predefined dose down- titration and/or expansion of dose interval in early arthritis with sustained DAS28-ESR \ 2.6 and established arthritis with a sustained DAS28-ESR \ 3.2. Primary outcome was time to relapse defined as increase in DAS28-ESR greater than 20 % over baseline. Cox’s regression analysis was performed to identify predictors of relapse. Sixty-four patients were included in the study. In the survival analysis, rates of relapse were 9.8 % at 6 months, 31.4 % at 12 months and 44.6 % at 18 months. Rates of patients with an increase in DAS28-ESR [ 20 % and C1 inflamed joint at 6, 9 and 18 months were 1.6, 17.2 and 27.1 %, respec- tively. In relapsing patients, mean DAS28-ESR at relapse was 3.44 (2.94–4.79) and mean DAS28-ESR following the return to the prior dose of the biologic was 2.52 (1.42–3.21). No predictors of relapse were found in multivariate analysis. Optimization of the treatment with biologics in RA is an efficacious and safe treatment option. Keywords Rheumatoid arthritis Á Optimization Á TNF antagonists Á Abatacept Á Tocilizumab Introduction Biologic therapies constitute a major advance in the treatment for rheumatoid arthritis (RA). Data provided by registries of biologics in RA show that 19–39 % of patients achieve clinical remission assessed by DAS28-ESR [1, 2]. However, the use of these drugs is not exempted from risks and represents an increase in costs [3]. This has raised the question of what to do with patients in a state of sustained remission. Discontinuation has been attempted. In several studies, relapse of the activity has been described in 40–75 % of patients with sustained remission after dis- continuation of treatment with TNF antagonists [4–8]. Currently, there is insufficient evidence to recommend discontinuation of the biologic treatment. Whether opti- mization of the biologic treatment by dose down-titration or dose interval expansion is better than discontinuation is unknown. Nevertheless, lower doses of biologics than the approved have been showed efficacious in different clinical trials [9, 10]. The aim of the present study is to analyse the effectiveness of a regimen of optimization of biologic therapies in RA patients. Methods To analyse the effectiveness of a regimen of optimization of TNF antagonists, tocilizumab (TCZ) and abatacept J. R. Maneiro (&) Á E. Perez-Pampin Á E. Salgado Á L. Carmona Á J. J. Gomez-Reino Rheumatology Department, Complejo Hospitalario Universitario de Santiago de Compostela, c/o Travesı ´a da Choupana s/n, 15701 Santiago de Compostela, Spain e-mail: joseramon.maneiro.fernandez@sergas.es L. Carmona Health Sciences School, Universidad Camilo Jose ´ Cela, Madrid, Spain J. J. Gomez-Reino Department of Medicine, Medical School, Universidad de Santiago, Santiago de Compostela, Spain 123 Rheumatol Int (2014) 34:1059–1063 DOI 10.1007/s00296-013-2839-4