Dose tapering and discontinuation of biological therapy in rheumatoid arthritis patients in routine care: 2-year outcomes and predictors

TY - JOUR

T1 - Dose tapering and discontinuation of biological therapy in rheumatoid arthritis patients in routine care

T2 - 2-year outcomes and predictors

AU - Brahe, Cecilie Heegaard

AU - Krabbe, Simon

AU - Østergaard, Mikkel

AU - Ørnbjerg, Lykke

AU - Glinatsi, Daniel

AU - Røgind, Henrik

AU - Jensen, Hanne S.

AU - Hansen, Annette

AU - Nørregaard, Jesper

AU - Jacobsen, Søren

AU - Terslev, Lene

AU - Huynh, Tuan K.

AU - Jensen, Dorte V.

AU - Manilo, Natalia

AU - Asmussen, Karsten

AU - Frandsen, Per Brown

AU - Boesen, Mikael

AU - Rastiemadabadi, Zoreh

AU - Carlsen, Lone Morsel

AU - Møller, Jakob M.

AU - Krogh, Niels S.

AU - Hetland, Merete Lund

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objectives. A cohort of routine care RA patients in sustained remission had biological DMARD (bDMARDs) tapered according to a treatment guideline. We studied: the proportion of patients whose bDMARD could be successfully tapered or discontinued; unwanted consequences of tapering/discontinuation; and potential baseline predictors of successful tapering and discontinuation. Methods. One-hundred-and-forty-three patients (91% receiving TNF inhibitor and 9% a non-TNF inhibitor) with sustained disease activity score (DAS28-CRP)<2.6 and no radiographic progression the previous year were included. bDMARD was reduced to two-thirds of standard dose at baseline, half after 16 weeks, and discontinued after 32 weeks. Patients who flared (defined as either DAS28-CRP>2.6 and ΔDAS28-CRP51.2 from baseline, or erosive progression on X-ray and/or MRI) stopped tapering and were escalated to the previous dose level. Results. One-hundred-and-forty-one patients completed 2-year follow-up. At 2 years, 87 patients (62%) had successfully tapered bDMARDs, with 26 (18%) receiving two-thirds of standard dose, 39 (28%) half dose and 22 (16%) having discontinued; and 54 patients (38%) were receiving full dose. ΔDAS28-CRP0-2yrs was 0.1((-0.2)-0.4) (median (interquartile range)) and mean ΔTotal-Sharp-Score0-2yrs was 0.01(1.15)(mean(S.D.)). Radiographic progression was observed in nine patients (7%). Successful tapering was independently predicted by: <1 previous bDMARD, male gender, low baseline MRI combined inflammation score or combined damage score. Negative IgM-RF predicted successful discontinuation. Conclusion. By implementing a clinical guideline, 62% of RA patients in sustained remission in routine care were successfully tapered, including 16% successfully discontinued at 2 years. Radiographic progression was rare. Maximum one bDMARDs, male gender, and low baseline MRI combined inflammation and combined damage scores were independent predictors for successful tapering.

AB - Objectives. A cohort of routine care RA patients in sustained remission had biological DMARD (bDMARDs) tapered according to a treatment guideline. We studied: the proportion of patients whose bDMARD could be successfully tapered or discontinued; unwanted consequences of tapering/discontinuation; and potential baseline predictors of successful tapering and discontinuation. Methods. One-hundred-and-forty-three patients (91% receiving TNF inhibitor and 9% a non-TNF inhibitor) with sustained disease activity score (DAS28-CRP)<2.6 and no radiographic progression the previous year were included. bDMARD was reduced to two-thirds of standard dose at baseline, half after 16 weeks, and discontinued after 32 weeks. Patients who flared (defined as either DAS28-CRP>2.6 and ΔDAS28-CRP51.2 from baseline, or erosive progression on X-ray and/or MRI) stopped tapering and were escalated to the previous dose level. Results. One-hundred-and-forty-one patients completed 2-year follow-up. At 2 years, 87 patients (62%) had successfully tapered bDMARDs, with 26 (18%) receiving two-thirds of standard dose, 39 (28%) half dose and 22 (16%) having discontinued; and 54 patients (38%) were receiving full dose. ΔDAS28-CRP0-2yrs was 0.1((-0.2)-0.4) (median (interquartile range)) and mean ΔTotal-Sharp-Score0-2yrs was 0.01(1.15)(mean(S.D.)). Radiographic progression was observed in nine patients (7%). Successful tapering was independently predicted by: <1 previous bDMARD, male gender, low baseline MRI combined inflammation score or combined damage score. Negative IgM-RF predicted successful discontinuation. Conclusion. By implementing a clinical guideline, 62% of RA patients in sustained remission in routine care were successfully tapered, including 16% successfully discontinued at 2 years. Radiographic progression was rare. Maximum one bDMARDs, male gender, and low baseline MRI combined inflammation and combined damage scores were independent predictors for successful tapering.

KW - bDMARD

KW - Biomarkers

KW - Prediction

KW - RA

KW - Radiographic progression

KW - Remission

KW - Successful dose tapering

KW - Tapering

U2 - 10.1093/rheumatology/key244

DO - 10.1093/rheumatology/key244

M3 - Journal article

C2 - 30169706

AN - SCOPUS:85059290377

SN - 1462-0324

VL - 58

SP - 110

EP - 119

JO - Rheumatology

JF - Rheumatology

IS - 1

ER -