Disease Activity-Guided Dosing Safe, Effective for up to 10 Years in Rheumatoid Arthritis

New research presented at the European Congress of Rheumatology (EULAR) 2023 annual meeting provides insight into the 10-year effectiveness of disease activity-guided drug optimization in patients with rheumatoid arthritis.

An observational follow-up of patients who completed the Dose Reduction Strategy of Subcutaneous TNFi (DRESS) study, results of the analysis, which included data from 170 of the original 180, suggest disease activity-guided drug optimization of TNF inhibitors, including full discontinuation, for up to 10 years.¹

A 3-year study evaluating disease activity-guided dose optimization, the DRESS study was published in 2017 and provided an overview of the safety and efficacy of disease activity-guided TNF inhibitor dose reduction in rheumatoid arthritis, with results indicating the benefits of treatment were maintained for up to 3 years, even with a large reduction in TNF inhibitor use, but no other benefits were observed.²

Citing an interest in the long-term safety and efficacy of disease activity-guided dose optimization, Noortje van Herwaarden, MD, PhD, of the Radboud University Medical Center, and a team of investigators designed the current study as an analysis of 10-year effectiveness among patients from with the DRESS study. With this in mind, the investigators’ analyses had 4 specific aims: assess disease activity over time, determine biological and targeted synthetic disease-modifying anti-rheumatic drug (b/tsDMARD) dose over time, estimate the proportion of patients with a DAGDO attempt, and estimate the proportion of patients with a discontinuation attempt and duration of b/tsDMARD discontinuation.¹

As part of DRESS protocol, patients who completed the 3-year DRESS extension were followed observationally for up to 10 years. In the study, disease activity-guided dose optimization was defined as: 100% to 66% to 50% to 33% to 0% (full discontinuation), with each percentage representing a portion of the current daily dose.¹

Among the 170 patients included in the current study, the median follow-up time was 10.0 (IQR, 9.3-10.3) years and the mean time-weighted DAS28-CRP during the entire follow-up period was 2.13 (95% confidence interval [CI], 2.10-2.16). Upon analysis, results suggested the TNF inhibitor dose decreased from 97% (95% CI, 96-99) at baseline to 49% (95% CI, 42-56) at year 5 and remained stable through end of follow-up.¹

Further analysis of 161 patients with at least 1 disease activity-guided dose optimization suggested 74% (95% CI, 66-80) tapered until full discontinuation. Among those achieving full discontinuation, the median time from discontinuation to restart of the first discontinuation attempt was 8 (IQR 3-45) months. Investigators also pointed out 25 patients never had to restart their TNF inhibitor or another b/tsDMARD during the study.¹

With an interest in learning more about how these results might help inform care, our editorial team sat down van Herwaarden during their time on-site at EULAR 2023.

Dr. van Herwaarden has no relevant disclosures to report.

References:

1. Van der Togt C, Den Broader N, Van der Maas A, Den Broeder A, Van Herwaarden N. DISEASE ACTIVITY-GUIDED DOSE OPTIMIZATION INCLUDING DISCONTINUATION OF TNF-INHIBITORS IN RHEUMATOID ARTHRITIS IS EFFECTIVE FOR UP TO 10 YEARS: RESULTS OF THE DRESS STUDY. Paper presented at: European Congress of Rheumatology (EULAR) 2023. Milan, Italy. May 31 – June 3, 2023.
2. Bouman CA, van Herwaarden N, van den Hoogen FH, et al. Long-term outcomes after disease activity-guided dose reduction of TNF inhibition in rheumatoid arthritis: 3-year data of the DRESS study - a randomised controlled pragmatic non-inferiority strategy trial. Ann Rheum Dis. 2017;76(10):1716-1722. doi:10.1136/annrheumdis-2017-211169