- 62% of patients with rheumatoid arthritis (RA) in sustained remission are successfully tapered or discontinued from biological DMARDs (bDMARDs) in usual care.
Why this matters
- Patients starting bDMARDs may be advised that they may not be permanently needed.
- Prospective cohort of 143 patients with RA in sustained remission (28-joint Disease Activity Score with CRP ≤2.6 and no radiographic progression during the previous year) who were tapered by two-thirds of standard dose at baseline, half after 16 weeks, and discontinued after 32 weeks.
- Patients who flared or progressed radiologically were stopped from tapering and escalated to previous dose.
- Funding: Capital Region, Denmark; Center for Rheumatology and Spine Diseases, Rigshospitalet.
- 141/143 patients were followed for 2 years, 91% of whom were receiving TNF inhibitors at baseline.
- 62% of patients (87/141) were successfully tapered or discontinued at the end of 2 years.
- 26/87 (29.9%) received two-thirds of standard dose;
- 39/87 (44.8%) received half of standard dose; and
- 22/87 (25.3%) were discontinued.
- Predictors of successful tapering were:
- ≤1 previous bDMARD (OR, 0.44; P=.004);
- Low baseline MRI combined inflammation score (OR, 0.92; P=.02); and
- Low combined damage score (OR, 0.99; P=.04).
- Predictor of successful discontinuation was negative IgM-rheumatoid factor (OR, 3.29; P=.015).
- Observational design.