RA: biologics successfully tapered or stopped for 62% of patients in remission

  • Rheumatol

  • curated by Miriam Davis, PhD
  • Clinical Essentials
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Takeaway

  • 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.

Study design

  • 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.

Key results

  • 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).

Limitations

  • Observational design.

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