Tapering of Biologics for Rheumatoid Arthritis Successful, Cost-Effective in Patients with Low Disease Activity

Patients with rheumatoid arthritis and low disease activity or remission may be able to successfully taper their treatment with biologic disease-modifying antirheumatic drugs (bDMARDS), according to the results of a recent study presented at the 2018 ACR/ARHP Annual Meeting, October 19-24, 2018, in Chicago, Illinois.

Rheumatoid arthritis affects more than 1.3 million individuals in the United States; 75% of those affected are women. Past research has demonstrated that patients with rheumatoid arthritis with low disease activity or remission can taper bDMARDS with success; however, more information is needed on the proportion of patients in whom this is possible in daily practice, as well as their characteristics.

As such, investigators from multiple institutions across Belgium performed a retrospective study and analyzed data on 332 patients with rheumatoid arthritis in the Brussels UCL cohort who were treated with a bDMARD for at least 1 year, according to the study abstract. The following anti-TNF agents were prescribed most frequently among this cohort: anti-TNF 68%, tocilizumab 15%, rituximab 10%, abatacept 7%.

Once sustained low disease activity or remission was achieved, a dose reduction was recommended. Investigators captured patient characteristics and baseline features prior to the introduction of the bDMARD and if at any point a flare occurred. The investigators also calculated the proportion of patients with rheumatoid arthritis who received a decreased dose and the annual cost of doing so to determine their secondary objective of which bDMARDs were better suited for reduced dosing and decreased cost.

Of the 332 patients included in the analysis, 140 received a decreased dose regimen and 192 received a full dose of a bDMARD. Patients were similar across groups for gender, anti-citrullinated protein antibodies, “erosion, number of previous bDMARDs, time to first conventional synthetic DMARD and biological DMARD, baseline DAS28-CRP and use of glucocorticoids,” wrote the authors.

Statistically different results were reported in the decreased dose group for the following: age at diagnosis (43.1 vs 38.7 years, P = .004), Health Assessment Questionnaire (1.3 vs 1.5, P = .048), Rheumatoid Factor (83.3 vs 72.9%, P = .026) and disease duration at the bDMARD introduction (9.7 vs 12.1 years, P =.034).

The disease activity score (DAS28-CRP) was found to be lower in the decreased dose group (2.26 vs 2.64, P = .001). Furthermore, more patients in the decreased dose group had been treated with methotrexate and the bDMARD when the bDMARD was first introduced (86.7% vs 73.8%, P = .005).

Fifteen patients experienced a flare up during follow-up.

The following medications were decreased most frequently and also associated with the greatest impact in terms of reduction of annual cost: adalimumab, etanercept, and rituximab.

“Tapering of biologics is essential in daily care. The unmet needs for this research are numerous, including the physician’s decision not to follow guidelines addressed by the industry,” said study coauthor Patrick Durez, MD, head of clinic, division of Rheumatology, Université Catholique de Louvain (UCLouvain), Brussels, in a statement on the study.

Based on these results, the investigators suggest that many patients with rheumatoid arthritis who have low disease activity or remission can successfully taper bDMARDs, which can also reduce annual costs.

Reference

Dierckx S, Lauwerys BR, Sokolova T, Meric de Bellefon L, Stoenoiu M, Nzeusseu Toukap A, Houssiau FA, Avramovska A, Durez P. Tapering of Biological Antirheumatic Drugs in Rheumatoid Arthritis Patients Is Achievable and Cost Effective in Daily Clinical Practice: DATA from the Brussels UCL RA Cohort [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 10). https://acrabstracts.org/abstract/tapering-of-biological-antirheumatic-drugs-in-rheumatoid-arthritis-patients-is-achievable-and-cost-effective-in-daily-clinical-practice-data-from-the-brussels-ucl-ra-cohort/. Accessed October 21, 2018.