Background/Purpose:

Current guidelines on RA treatment recommend tapering of biologic DMARDs for patients in persistent remission.

Methods:

In this retrospective study we used the hospital administrative database to identify patients with a diagnosis of RA and a first time prescription of a biologic DMARD that was specifically limited to one of the 3 TNF inhibitors (etanercept, adalimumab, infliximab) between January 2012 and the end of December 2013. Patient demographics and information on treatment and outcome were retrieved from the medical charts.

Results:

Of the 125 patients identified at the database search, 104 were registered in our clinic and had available follow-up until June 2016. Seventy-nine (76%) were women and 25 (24%) were men. Their mean age was 47.7±13 SD years and their mean disease duration was 7.4±6.9 SD years. The distribution of the prescribed TNF inhibitors was: Etanercept = 60%, Adalimumab = 23% and Infliximab = 17%. After a mean duration of 14.0±7.6 SD months tapering of TNF inhibitors was made in 44 patients (42%). This was in the form of spacing in 39 patients (Etanercept =16, Infliximab = 14, Adalimumab = 9) and dose reduction in 5 (all Etanercept). All of these were due to good clinical response except for 1 patient’s own request because of fear from possible adverse effects. Increased disease activity after tapering was seen in 16 patients (36%) mandating restoration of original dose schedule within a mean of 8.8±9.7 SD months with good response in all. On the other hand 28 patients (64%) preserved their good clinical response during a mean follow-up of 46.1±6.3 SD months which enabled further tapering in 20 of them. There was also reductions in the mean number of synthetic DMARD’s (1.4±0.8 SD at the initiation of TNF inhibitors and 0.7±0.8 SD at the end of follow-up) and in the percentage of patients using steroids (78% vs 33%). At the end of the follow-up, among the whole group of 104 patients, only 73 (70%) were using biologics (TNF inhibitors = 49, non-TNF biologics = 24). The reasons for stopping biologics in the remaining 31 patients were ongoing remission (16 patients; 15%), pregnancy (1 patient), non-compliance (4 patients), injection site reactions (3 patients), fear from adverse events (1 patient), decision for complementary medicine (1 patient) and other issues such as losing insurance and family issues (5 patients).

Conclusion:

Tapering of TNF inhibitors was possible in 40% of RA patients during follow-up. One third of the patients flared after tapering whereas the remaining two thirds maintained their good outcome allowing cessation in 15%. Further studies are needed to identify factors predicting successful tapering.

« Back to 2017 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/tapering-tnf-inhibitors-in-rheumatoid-arthritis-a-retrospective-study/