PMS74 TAPERING BIOLOGIC? AN INSIGHT AND PERSPECTIVE OF RHEUMATOID ARTHRITIS PATIENTS

Abstract

Implementation of 'treat-to-target' strategies and development of biologic have made remission possible for many people with rheumatoid arthritis (RA). As more RA patients achieved clinical remission, tapering of biologic has been advocated as the next step in the long-term management of the disease. Recent clinical trials highlighted the feasibility of this approach, but little is known about tapering biologic from the perspective of RA patients. This study seeks to understand how RA patients approach the risk-benefit trade-offs associated with tapering biologic. Participants diagnosed with RA and currently taking biologic were eligible to participate in focus groups or individual interviews. All interviews were tape-recorded, transcribed verbatim and analyzed thematically. 45 patients participated in either 1 of 6 focus groups or an in-depth individual interview. Five themes emerged: fear of the uncertainty of outcome, prioritizing quality of life over the risk of adverse effects, relief from medication burden, healthcare system support, and preference for involvement in decision-making. Participants acknowledged tapering their biologic would provide some relief and a certain freedom in their daily life but were fearful it may precipitate a disease relapse. They were willing to accept the risk of adverse effect associated with long-term biologic treatment in exchange for a better quality of life. When considering tapering, participants wanted an assurance of access to treatment and consultation when flare occurs. Furthermore, participants would prefer to make the decision to taper biologic together with their rheumatologist. Concerns of uncontrolled disease and prompt access to treatment when disease flares are among the key issues that need to be addressed when discussing the possibility of biologic tapering in daily practice. A shared decision-making approach can facilitate a greater patients' understanding of the risks and benefits involved in tapering their biologic, leading to greater acceptance and adherence to treatment.