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Abstract Number: 414

Multi-Biomarker Disease Activity and Autoantibody Status Lead to Cost Effective Tapering Algorithms in Rheumatoid Arthritis Patients in Sustained Remission

Melanie Hagen1, Matthias Englbrecht2, Judith Haschka3, Michaela Reiser4, Arnd Kleyer5, Axel J. Hueber6, Bernhard Manger7, Camille Figueiredo8, Jayme Fogagnolo Cobra9, Hans-Peter Tony10, Stefanie Finzel11, Stefan Kleinert12, Joerg Wendler13, Florian Schuch13, Monika Ronneberger13, Martin Feuchtenberger14, Martin Fleck15,16, Karin Manger17, Matthias Schmitt-Haendle18, H.-M. Lorenz19, HG Nüßlein20, Rieke Alten21, Joerg C. Henes22, Klaus Krüger23, Georg Schett2 and Juergen Rech24, 1University of Erlangen-Nuremberg, Erlangen, Germany, 2Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany, 3Medical Department II, St. Vincent Hospital, the VINFORCE Study Group, Academic Teaching Hospital of Medical University of Vienna, Vienna, Austria, Vienna, Austria, 4Department of Medicine 3, Rheumatology and Immunology, University of Erlangen-Nuremberg, Erlangen, Germany, 5Dept of Medicine 3, Rheumatology and Clinical Immunology, Department of Internal Medicine 3 – Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany, 6Department of Internal Medicine 3 and Institute for Clinical Immunology, University of Erlangen-Nuremberg, Erlangen, Germany, 7Dept of Medicine 3, Rheumatology and Clinical Immunology, University of Erlangen-Nuremberg, Erlangen, Germany, 8Institution de Rheumatologia, Sao Paolo, Brazil, 9Instituto de Reumatologia de Sao Paolo, Sao Paolo, Brazil, 10Rheumatology/Clinical Immunology, University of Würzburg, Würzburg, Germany, 11University of Freiburg, Freiburg, Germany, 12Rheumatologische Schwerpunktpraxis Erlangen, Erlangen, Germany, 13Schwerpunktpraxis Rheumatologie, Erlangen, Germany, 14Rheumatologie/Klinische Immunologie, Kreiskliniken Altötting-Burghausen, Burghausen, Germany, 15Department of Rheumatology and Clinical Immunology, Asklepios Medical Center Bad Abbach, Bad Abbach, Germany, 16Internal Medicine I, University Medical Center of Regensburg, Regensburg, Germany, 17Rheumatology Practice Bamberg, Bamberg, Germany, 18Rheumatology Practice, Bayreuth, Germany, Bayreuth, Germany, 19Rheumatology, University Heidelberg, Heidelberg, Germany, 20Rheumatology Practice Nuremberg, Nuremberg, Germany, 21Schlosspark-Klinik, University Medicine Berlin, Berlin, Germany, 22Department of Internal Medicine II, Division of Rheumatology, University Hospital Tuebingen, Tuebingen, Germany, 23Praxiszentrum St.Bonifatius, Munich, Germany, 24Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany., Erlangen, Germany

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: Biomarkers, Economics, remission and rheumatoid arthritis (RA)

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Session Information

Date: Sunday, November 5, 2017

Session Title: Rheumatoid Arthritis – Clinical Aspects Poster I: Treatment Patterns and Response

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose:

Achieving remission is the ultimate treatment goal in patients with rheumatoid arthritis (RA). With the development and wider use of highly effective disease modifying anti-rheumatic drugs (DMARD) about half of RA patients reach the disease remission state (1), raising the question about tapering or stopping anti-rheumatic treatment and appropriate predictors (2). The purpose was to analyse the effect of a risk-stratified DMARD tapering algorithm based on multiple-biomarker disease activity (MBDA) score and anti-citrullinated protein (ACPA) status for successful DMARD tapering and treatment cost reduction in RA patients in sustained remission enrolled in the prospective randomized controlled RETRO study (3,4).

Methods: MBDA scores and ACPA status were determined in the baseline samples of 146. A patients in sustained remission. Patients either continued DMARDs (arm1), tapered dose by 50% (arm 2) or stopped DMARDs after tapering (arm 3) for one year according to the RETRO study protocol. Direct treatment costs (including testing costs at baseline) were evaluated every three months. MBDA and ACPA status were used as predictors creating a risk-stratified tapering algorithm based on relapse rates.

Results: RA patients with a low MBDA score (<30) and negative ACPA showed lowest relapse risk (19%). With either single positivity for ACPA or moderate/high MBDA scores (>30) relapse risk increased and was high in double-positive patients (61%). In MBDA negative (<30) and MBDA single-positive (>30) groups, DMARD tapering appears feasible. Considering only patients that did not flare, costs for synthetic and biologic DMARDs in the MBDA-negative and single-positive groups (n=41) would have been 123.751,29€ for full-dose treatment over one year. Tapering and stopping DMARDs in this low-risk relapse groups allowed a reduction of 92.821,50€ (-75%) of DMARD costs. Average reduction of DMARD costs per patient were 2.350,08€ in the double negative (MBDA- /ACPA-) and single negative (MBDA- /ACPA+) group and 1.761,43€ in the MBDA single positive (MBDA+ /ACPA-) group.

Conclusion: Combining MBDA score and ACPA status allows risk stratification for successful DMARD tapering and cost-effective use of biologic DMARD. Given that previous data of the RETRO have shown that patients relapsing after tapering their DMARDs respond well to their reintroduction, a stratified tapering and stopping of DMARDs is not only a cost economic but also clinically feasible strategy.


Disclosure: M. Hagen, None; M. Englbrecht, None; J. Haschka, None; M. Reiser, None; A. Kleyer, None; A. J. Hueber, None; B. Manger, None; C. Figueiredo, None; J. F. Cobra, None; H. P. Tony, None; S. Finzel, None; S. Kleinert, None; J. Wendler, None; F. Schuch, None; M. Ronneberger, None; M. Feuchtenberger, None; M. Fleck, None; K. Manger, None; M. Schmitt-Haendle, None; H. M. Lorenz, None; H. Nüßlein, None; R. Alten, None; J. C. Henes, None; K. Krüger, None; G. Schett, None; J. Rech, None.

To cite this abstract in AMA style:

Hagen M, Englbrecht M, Haschka J, Reiser M, Kleyer A, Hueber AJ, Manger B, Figueiredo C, Cobra JF, Tony HP, Finzel S, Kleinert S, Wendler J, Schuch F, Ronneberger M, Feuchtenberger M, Fleck M, Manger K, Schmitt-Haendle M, Lorenz HM, Nüßlein H, Alten R, Henes JC, Krüger K, Schett G, Rech J. Multi-Biomarker Disease Activity and Autoantibody Status Lead to Cost Effective Tapering Algorithms in Rheumatoid Arthritis Patients in Sustained Remission [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/multi-biomarker-disease-activity-and-autoantibody-status-lead-to-cost-effective-tapering-algorithms-in-rheumatoid-arthritis-patients-in-sustained-remission/. Accessed January 20, 2021.
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