Session Title: 5T089 ACR Abstract: RA–Treatments IV: Strategy (2820–2825)
Session Type: ACR Concurrent Abstract Session
Session Time: 2:30PM-4:00PM
Dose tapering and discontinuation of biological therapy in rheumatoid arthritis patients in routine care –
2-year outcomes and predictors
Background/Purpose: A cohort of routine care rheumatoid arthritis (RA) patients in sustained remission had biological disease-modifying anti-rheumatic drugs (bDMARDs) tapered according to a treatment guideline. We studied: 1) the proportion of patients whose bDMARD could be successfully tapered or discontinued; 2) unwanted consequences of tapering/discontinuation; 3) potential baseline predictors of successful tapering and discontinuation.
Methods: One-hundred-and-forty-three patients with sustained disease activity score (DAS28-CRP)≤2.6 and no radiographic progression the previous year were included. bDMARD was reduced to 2/3 of standard dose at baseline, ½ after 16 weeks, and discontinued after 32 weeks. Patients who flared (defined as either DAS28-CRP≥2.6 and DDAS28-CRP≥1.2 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 2/3 of standard dose, 39(28%) ½ dose and 22(16%) having discontinued; and 54 patients (38%) were receiving full dose. DDAS28-CRP0-2yrs was 0.1((−0.2)-0.4) (median(interquartile range)) and mean DTotal-Sharp-Score0-2yrs was 0.01(1.15)(mean(SD)). Radiographic progression was observed in 9 patients (7%). Successful tapering was independently predicted by: ≤1 previous bDMARD, male gender, low baseline MRI combined inflammation score or combined damage score (Figure). Negative IgM-rheumatoid factor predicted successful discontinuation. The “heat-map” for predicted probabilities for successful tapering based on logistic regression model including the 4 baseline variables are shown in Figure 2.
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.
To cite this abstract in AMA style:Brahe CH, Krabbe S, Østergaard M, Ørnbjerg LM, Glinatsi D, Rogind H, Jensen HS, Hansen A, Nørregaard J, Jacobsen S, Terslev L, Huynh TK, Jensen DV, Manilo N, Asmussen K, Brown-Frandsen P, Boesen M, Rastiemadabadi Z, Morsel-Carlsen L, Møller JM, Krogh NS, Hetland ML. Dose Tapering and Discontinuation of Biological Therapy in Rheumatoid Arthritis Patients in Routine Care – 2-Year Outcomes and Predictors [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 10). https://acrabstracts.org/abstract/dose-tapering-and-discontinuation-of-biological-therapy-in-rheumatoid-arthritis-patients-in-routine-care-2-year-outcomes-and-predictors/. Accessed October 28, 2021.
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