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The remaining 26 patients experienced relapses that required a second course of therapy (Table 2).
A total of 178 patients received a second course of therapy with an alternative anti-TNF drug.
After an initial regression of the disease, a second course of therapy was given at a reduced dose due to the toxicity of the treatment, with an associated lesser therapeutic effect.
Our study clearly shows that RTX treatment, already from the second course of therapy, displayed a stronger and significant effect in decreasing the ESSDAI, when compared with the DMARD arm, and this effect was observed throughout the study period.
Out of these seven patients, two had a further disease recurrence at 12 and 18 months after the second course of therapy and responded to a third course of intralesional triamcinolone.
With the major caveat of the limited evidence generated, the comparative PKs on first vs second course suggest similar area under the curve and terminal half-life figures but a lower Cmax value on the second course of therapy.
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Interestingly, the one subject that underwent a second cycle of therapy after an 9-day interruption, rebounded to approximately the same 20% increase in private mutations that was observed during his first course of therapy.
Twenty patients underwent a third course of therapy.
All patients received tamoxifen as part of their first course of therapy.
Fifth, hormone users, particularly if they were healthier, might have received additional treatments beyond their first course of therapy.
The vast majority of patients (20/22; 91%) reached disease-free status at 2 weeks after the first course of therapy.
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Justyna Jupowicz-Kozak
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