Dose optimization of infliximab in patients with rheumatoid arthritis

Aim It is well established that tumor necrosis factor ( TNF ) inhibitors help control disease activity, limit radiographic progression and preserve function in patients with rheumatoid arthritis. However, not all patients respond adequately to initial anti‐ TNF treatment and some patients lose response over time. Possible treatment modifications include optimizing concomitant disease‐modifying antirheumatic drugs, switching to another anti‐ TNF biologic or another class of agent, or optimizing the dose of the anti‐ TNF agent. Here we review data on dose optimization of infliximab, with emphasis on dose changes to address inadequate response, nonresponse and loss of response. Method The authors conducted a literature review to identify studies that evaluated the effect of dose optimization on clinical response in infliximab‐treated patients with rheumatoid arthritis. Results Few well‐controlled studies of dose optimization of infliximab have been completed for patients with rheumatoid arthritis, and the evidence supporting efficacy and safety after dose adjustment can be difficult to interpret. Studies of dose optimization in infliximab‐treated patients who fail to show initial response, have an inadequate response, or lose response over time are not entirely consistent, but tend to show a pattern of improvement after a dose increase. Conclusion Dose optimization involves a balance of risks and benefits, and future research should seek to clarify which patients are most likely to benefit from dose optimization without undue increase in risk.