Background/Purpose: Tapering of biologics is now recommended in the management of people with RA in sustained remission.¹ Clinical studies have shown some RA patients can successfully taper their biologic without significant increases in disease activity or radiographic progression. However, little is known of RA patients’ perspectives about the possibility of tapering their biologic. This study sought to identify factors that may influence RA patients’ decision to taper their biologic.

Methods: Patients meeting the 2010 ACR/EULAR classification criteria for RA and currently taking biologics were eligible to participate in focus groups or individual interviews. Patients with any level of disease activity were included to allow exploration of a wide range of perspectives and to avoid exclusion of potentially valuable insights. All interviews and focus group discussions were audio recorded and transcribed verbatim. Transcripts were coded using an established approach to thematic analysis² to determine themes relating to patients’ decision about tapering biologics.

Results: 128 eligible patients were invited, 76 declined or did not respond and 7 were unavailable. 45 participants were involved in either 1 of 6 focus groups (n=43) or an in-depth individual interview (n=2). Around two-thirds of participants were receiving biologics via infusion and the remaining were self-injecting. Five themes were identified: fear of the uncertainty of outcomes, prioritizing quality of life over the risk of adverse effects, relief from medication burden, healthcare system support, and preference for involvement in decision-making. Participants had strong concerns that tapering their biologic might lead to periods of uncontrolled disease activity leading to joint damage. Their desire for better quality of life outweighed the concern of adverse effects associated with long-term biologic use. Nevertheless, participants recognized a lower frequency of administration would provide convenience in some aspects of daily life. Prompt reinitiation of biologics and consultation with the rheumatology team if flares occur when tapering are crucial from the perspective of the participants. Furthermore, participants would prefer to make the decision to taper biologics together with their rheumatologist.

Conclusion: Concerns of uncontrolled disease and receiving access to treatment when disease flares are among the key issues that need to be addressed when planning tapering protocols. Tool to aid shared decision making may facilitate the exchange of information, improve patients’ knowledge and understanding of the benefits and risks involved in tapering their biologic leading to greater acceptance of tapering.

Reference

1. Smolen et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update. Ann Rheum Dis. 2017;76(6):960-977
2. Braun et al. Using thematic analysis in psychology. Qualitative Research in Psychology. 2006;3(1):77-101

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/rheumatoid-arthritis-patients-perspectives-on-tapering-of-biologics-a-qualitative-study/