Abstract
Background/purposeStudies have demonstrated that rheumatoid arthritis (RA) patients who achieve low disease activity or remission are able to taper biological disease-modifying antirheumatic drugs (bDMARDs). The aim of this study was to evaluate the proportion of patients in whom bDMARDs can be tapered in daily practice and to analyse the characteristics of these patients. Other objectives were to analyse which bDMARDs are more suitable for dose reduction and the cost savings.ResultsData from 332 eligible RA patients from our Brussels UCLouvain cohort were retrospectively analysed; 140 patients (42.1%) received a tapered regimen, and 192 received stable doses of bDMARDs. The age at diagnosis (43.1 vs 38.7 years, p = 0.04), health assessment questionnaire (HAQ) score (1.3 vs 1.5, p = 0.048), RF positivity rate (83.3 vs 72.9%, p = 0.04) and disease duration at the time of bDMARD introduction (9.7 vs 12.1 years, p = 0.034) were significantly different between the reduced-dose and stable-dose groups. Interestingly, relatively more patients receiving a tapered dose were treated with a combination of bDMARDs and methotrexate (MTX) (86.7% vs 73.8%, p = 0.005). In our cohort, anti-TNF agents were the most commonly prescribed medications (68%). Only 15 patients experienced a flare during follow-up. Adalimumab, etanercept and rituximab were the most common bDMARDs in the reduced-dose group and were associated with the most important reductions in annual cost.ConclusionIn daily practice, tapering bDMARDs in RA patients who have achieved low disease activity or remission is an achievable goal in a large proportion of patients, thereby reducing potential side effects and annual drug-associated costs. The combination of bDMARDs with MTX could improve the success of dose reduction attempts.Trial registrationThis retrospective non-interventional study was retrospectively registered with local ethics approval.
Highlights
Rheumatoid arthritis (RA) can lead to major deformities and loss of function, especially in the absence of a clinical response
There was no statistically significant difference in disease duration since the introduction of the first conventional synthetic DMARD (csDMARD) or Biological disease-modifying antirheumatic drugs (bDMARDs) treatment, but the duration of disease at the introduction of the current bDMARD treatment was significantly shorter in the reduced-dose group than in the stable-dose group (9.7 vs 12.1 years, p = 0.034) (Table 1)
Our study showed that different baseline RA characteristics were correlated with the success of the bDMARD dose decrease, such as the age at diagnosis, presence of rheumatoid factor (RF), disease duration at the introduction of the first bDMARD, health assessment questionnaire (HAQ) score, patient global assessment (PGA) score and combination with MTX
Summary
Rheumatoid arthritis (RA) can lead to major deformities and loss of function, especially in the absence of a clinical response. Biological disease-modifying antirheumatic drugs (bDMARDs) have considerably improved the prognosis of RA. In clinical practice, these agents have led to remission or low disease activity (LDA) in many RA patients. The question has arisen as to whether long-term treatment with the full dose of bDMARDs is necessary in patients who achieve the objective of remission or LDA. The strategy to reduce the doses of bDMARDs has potentially beneficial effects in several areas, such as the risk of side effects, especially infections; the comfort of the patient; and the economic impact of the drug [2, 3] Care strategies have been developed, including the “treat to target” approach recommended by the European League Against Rheumatism (EULAR), which suggests initiating treatment quickly once the diagnosis is established and adapting it until remission or LDA is reached [1, 2].
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
