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 Fleck^15,16, 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)

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 November 14, 2019.

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