This site is intended for UK healthcare professionals
Medscape UK Univadis Logo
Medscape UK Univadis Logo
Clinical Summary

Rheumatoid arthritis: conventional or biologic DMARDs, which to taper first?

Takeaway

  • The TARA trial found no significant differences in disease flare among patients with rheumatoid arthritis (RA) controlled with combination therapy who first taper TNF-inhibitor biologic DMARDs (TNFi-DMARD) vs conventional synthetic DMARDs (csDMARDs).

Why this matters

  • The authors recommend tapering first with the TNFi because of cost reductions and potential for fewer adverse events by continuing to receive csDMARDs.

Study design

  • Randomized controlled trial of 189 patients with RA with controlled disease (Disease Activity Score [DAS], ≤2.4; Swollen Joint Count [SJC], ≤1) assigned to 1 of 2 groups: taper first with TNFi-DMARD or with csDMARD.
  • Primary outcome: proportion of patients with disease flare (DAS >2.4 and/or SJC >1).
  • Funding: Netherlands Organization for Health Research and Development.

Key results

  • Up to 9 months, no difference between groups in flare rates after tapering TNFi or csDMARDs first.
  • After 1 year, the cumulative flare rate was nonsignificantly superior in favor of tapering first the csDMARD (33% vs 43%; P=.17).
  • After 1 year, there was no difference in secondary outcomes, DAS (P=.72), European Quality of Life-5 Dimensions (EQ-5D; P=.58), and functional ability (Health Assessment Questionnaire Disability Index [HAQ-DI]; P=.63).

Limitations

  • Difficulties in recruitment.

References


YOU MAY ALSO LIKE