Background/Purpose: However biological DMARDs (bDMARDs) and treatment strategies have improved the outcomes of rheumatoid arthritis (RA), it is unknown who can taper or stop bDMARDs and strategies for de-escalation.
We analyze predictors of tapering of withdrawal failure in rheumatoid arthritis (RA) patients treated with abatacept.This study will assess and compare (1) characteristic of patients who achieve remission (REM) or low disease activity (LDA) as who can taper abatacept and (2) two de-escalation methods, rapidly and gradually de-escalation in patients who respond first-line therapy.

Methods: Cases were recruited to SHin-yokohama Arthritis REgister (SHARE) between 2015 and 2019 (n=3,674). Patients were diagnosed according to ACR/EULAR 2010 classification criteria, and treated with DMARDs which included abatacept (n=248). In 248 (Male24, Female224 cases, RA duration 11.3+/-8.0 years, CDAI 24.5+/-14.7) cases, Clinical Disease Activity Index (CDAI) , Health Assessment Questionnarie-Disability Index (HAQ-DI), anti-CCP2 and patients clinical parameters were analyzed. Two de-escalation methods were compared in this study. In rapidly de-escalation methods, abatacept were decreased to half dose in patients with stable REM/LDA over 12 weeks. In gradually de-escalation methods, abatacept were decreased to 75%, 50%, 33%, 25%, 20%, 17%, 14%, 12.5% in order with stable REM/LDA over 12 weeks.

Results: Of 248 patients, 161 patients (73.2%) were achieved to REM and/or LDA within 6 months after using abatacept.
(1) Multivariate logistic regression examined the predictors to detect who can taper abatacept. Higher anti-CCP2 titer patients were correlate with patients who achieve remission (REM) or low disease activity (LDA) in patients treated with abatacept (OR 0.99, 95%CI 0.994-0.999, p=0.0016). ROC analysis of anti-CCP2 showed cut-off value of 84.5 U/ml with the area under the curve was 0.7633.    (2) Comparison of sustained REM and/or LDA rate between rapidly and gradually de-escalation methods of abatacept in rheumatoid arthritis. 11 cases were tapered abatacept with rapidly de-escalation method and 88 patients were with gradually de-escalation method. Gradually de-escalation method showed less relapse rate tapered abatacept after 6 months (6.8% vs. 63.6%, p< 0.0001) and showed less swollen joints (0.1+/10.6 joints vs. 0.4+/-0.7 joints, p=0.004) compared with rapidly de-escalation method. (3) Sustained REM and/or LDA rate after tapered abatacept using gradually de-escalation method were 63.4% in 12 months and 82.7% in 24 months.

Conclusion: A combination of high anti-CCP2 titer and tapering abatacept using gradually de-escalation method may help to predict successful abatacept deduction in RA patients with sustained clinical REM and/or LDA.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/comparison-of-sustained-clinical-remission-and-or-low-disease-activity-rate-between-rapidly-and-gradually-de-escalation-of-abatacept-in-rheumatoid-arthritis/