Date: Monday, November 6, 2017
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Tapering trials confirmed the feasibility of TNF inhibitors (TNFi) tapering for a relevant proportion of patients in remission and/or low disease activity. However, there are no consensual predictors of a good response to therapeutic spacing among patients with rheumatoid arthritis (RA) in remission. We aimed to develop a predictive score of successful TNFi tapering.
Post-hoc analysis of a controlled trial of a tapering strategy in RA patients, fulfilling ACR 1987 criteria, treated with subcutaneous TNFi with sustained remission, randomized to either spacing or maintaining TNFi. We used the data of the Spacing arm.
Performances of several variables (DAS28, SDAI, CDAI, CRP, ACPA status, HAQ, patient/physician global assessment, and booleen remission criteria) were assessed for the prediction of successful TNFi tapering, defined as reaching at least 25% tapering of the full regimen during at least 6 months, using sensitivity (Se) and specificity (Spe) for dichotomous variables, or the area under the ROC curve (AUC) and its 95% confidence interval for continuous variables.
A predictive score of successful tapering was constructed using LASSO regression modeling to avoid overfitting (R software version 3.2.1).
The main characteristic of the 64 patients of the Spacing arm were the following (mean ± SD): age 54.3 ± 10.7 years, disease duration 8.3 ± 5.4 years, and DAS 28 1.9 ± 0.6.
The baseline variables were similar between patients who failed or succeeded at TNFi spacing, except for the HAQ score (0.30 in the group success and 0.89 in the failure group, p = 0.01) and the CRP (2.35 mg/l versus 3.48 mg/l, respectively, p=0.02).
Baseline variable performance in predicting successful TNFi spacing: None of the tested variables was able to predict successful TNFi spacing, except the HAQ score and the CRP. A HAQ threshold ≥ 1.125 had a Spe of 93% and an AUC: 0.713 (CI95%: 0.540-0.886). A CRP threshold ≥ 6.8 mg/l had a Spe of 0.97 and an AUC: 0.689 (CI95%: 0.547-0.831).
Predicting score: A composite score able to predict successful TNFi spacing has been elaborated, including ACPA status, Boolean criteria, SDAI, CRP and HAQ. A 0.5 threshold predicted successful TNFi spacing with Spe = 100% and Se = 54% (AUC: 0.829; CI95%: 0.671 – 0.986).
The remission maintenance in rheumatoid arthritis after TNFi spacing is possible. Our results showed that in a population of RA patients in remission with TNFi, baseline HAQ and CRP are independent predictor factors of successful tapering. We have developed a composite index able to predict successful TNFi spacing, with an AUC of 0.829 and a 100% Spe. A validation study will be needed to confirm its ability to select patients for treatment decrease.
To cite this abstract in AMA style:Barral C, Hajage D, Fautrel B, Lafforgue P, Tubach F, Pham T. Development of a Predictive Score of Successful TNF Inhibitor Tapering in Patients with Rheumatoid Arthritis Remission [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/development-of-a-predictive-score-of-successful-tnf-inhibitor-tapering-in-patients-with-rheumatoid-arthritis-remission/. Accessed September 25, 2021.
« Back to 2017 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/development-of-a-predictive-score-of-successful-tnf-inhibitor-tapering-in-patients-with-rheumatoid-arthritis-remission/