The recent strategy for rheumatoid arthritis (RA) management mainly focuses on achieving clinical remission. After the remission is attained and sustained over time, the better efficient strategy is dose optimization. The recent study published in Rheumatology International explained the results of dose optimization after 2 years of follow-up in patients with RA treated with biological therapy and identifies predictive variables of response.

The study included a cohort of patients from the CREATE registry who, as of 1 November 2013, had been in clinical remission (DAS28 ≤2.6) for at least 6 months. Dose optimization was 20–50% of the standard dose. Outcome measures were effectiveness (percentage of patients who continued to meet criteria for clinical remission) and efficiency (dose reduction and mean savings). A total of 68 RA patients were optimized, with initial mean DAS28 of 2.2 ± 0.7. After 2 years of follow-up, the mean DAS28 was 2.4 ± 0.7 that indicate a non-statistically significant difference. Of all, 28 patients (41.2%) continued in clinical remission with dose optimization after 2 years. Mean survival time was 14.2 months (95% CI 12.0–16.5). Of the 40 patients who needed to return to a standard dose, 57.5% managed to achieve remission again at 2 years. Mean dose reduction at 2 years was 21.17%, reaching a mean saving of €5576 ± 5099 per patient. In actual clinical practice, over 40% of patients with established RA who had been in sustained clinical remission managed to continue in remission 2 years after receiving optimized doses. The savings achieved was about 21% of the actual direct health costs for patients in the CREATE registry.