Background/Purpose: Clinical trials have shown that in many patients tapering and/or stopping antirheumatic medication is a realistic option. We interviewed patients to investigate their opinions, expectations and emotions with regard to tapering and discontinuing antirheumatic drugs.

Methods: 20 patients randomly identified at the rheumatology outpatient clinic were asked 12 questions through structured interviewing by two investigators (10 patients each). Interviews were sound recorded, typed out in full and screened by three assessors independently for content items. After 20 interviews, data saturation was reached.

Results: Mean (SD) age was 64.6 (15.2) years and median (minimum; maximum) disease duration was 15.0 (0.1; 40.0) years. 13 patients were female. Disease Activity Score (DAS) was ≤ 2.4 in 13 patients, even <1.6 in 8 patients, and >2.4 in 7 patients. 17 patients used antirheumatic medication at the moment of interviewing.

Six patients were of the opinion that discontinuing is a possibility for both other patients and themselves, one patient thought only tapering could be possible and five did not see this possibility. Two patients thought it could be possible for other patients, but not for themselves.

Patients’ replies conveyed hope (being free from symptoms), happiness and relief (being free from drugs), fear (for a disease flare) and faith (in the decision of the rheumatologist) as feelings about tapering/ discontinuing their medication. Conditions mentioned before a drug holiday might be tried were longstanding low disease activity, first tapering before stopping, intensive monitoring. Severe side effects were also a motive to stop medication.

Ten patients expected increased disease activity after stopping medication, four expected that low disease activity would be maintained, and four patients thought both could happen. Most patients expect that disease activity will decrease again after restarting medication, but they also expect that this will take (too much) time. 

Conclusion: Although most patients are unaware of the option to taper and discontinue  antirheumatic medication, patients express positive emotions about this option. However, they also have concerns that disease activity will flare and they expect that improvement upon restarting medication will take time. Patients’ expectations and feelings should be addressed before a drug holiday is attempted.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/drug-free-holiday-in-patients-with-rheumatoid-arthritis-ra-patients-opinion/