Session Information
Date: Sunday, October 21, 2018
Title: Rheumatoid Arthritis – Treatments Poster I: Strategy and Epidemiology
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: Recommendations and guidelines for the management of Rheumatoid Arthritis (RA) and spondyloarthritis (SpA) with bDMARD include dose-tapering as an adequate option for patients on persistent remission. Although data regarding these strategies has increased in recent years, there is scarce evidence about their long-term effectiveness.
Our aim was to analyze the persistence of bDMARD dose-reduction in clinical practice and evaluate its predictors in patients with inflammatory arthritis with up to seven years of follow-up.
Methods:
Variables analyzed were: persistence of bDMARD dose-reduction, outcomes of patients requiring its withdrawal, predictors of persistence reported in the literature such as glucocorticoid (GC) and previous bDMARD use, disease activity and duration of disease at dose reduction as well as demographic and clinical features. A logistic regression model was used to identify factors associated with persistence on reduced-dose regimen after 7 years of follow-up
Results: 56 patients (RA:33; SpA:23) on tapered bDMARD (etanercept 51.8%, adalimumab 32.1%, Infliximab 3.6% and tocilizumab 12.5%) at study entry were included. Their clinical and laboratory features are shown in table 1.
After a mean follow-up on tapered-dose of 4.4 ± 2.6 years, 42.9% of subjects overall remained treated with this strategy (RA: 36.4%; SpA: 52.2%).
From those who required discontinuation of the step-down regimen, 15 (48.4%) achieved the therapeutic objective and 7 (22.6%) failed after returning to standard dose respectively. bDMARD were discontinued in 4 (12.9%) patients due to sustained disease remission (RA=3; SpA=1), 3 (9.7%) due to adverse events and 2 (6.4%) due to other reasons.
No significant differences in the different variables analyzed were found between patients continuing vs discontinuing reduced-dose regimens. Only disease duration at dose-reduction was associated with persistence of bDMARD step-down strategy overall (AOR: 1.13; 95% CI 1.01-1.26; p 0.02) in multivariate analysis.
Conclusion: A significant proportion of patients with RA and SpA (36.4% and 52.2% respectively) can be maintained with reduced doses of bDMARD after a long-term follow-up. Disease duration was the only predictor of dose-tapering persistence overall.
References:
1 Inciarte-Mundo J et al. Reumatol Clin. 2014;10(1):10–16
Table 1. Demographic and clinical features at bDMARD dose-reduction.
|
Total n: 56 |
Continue tapered bDMARD n: 24 |
Withdrawn tapered bDMARD n:32 |
|
|
Age |
52.3 ± 14.3 |
53.9 ± 13.9 |
51.1 ± 14.7 |
|
Female |
32 (57.1%) |
10 (41.7%) |
22 (68.7%) |
|
Smoking status (ever smokers) |
25% |
23.8 % |
26.1% |
|
Diagnostics |
|||
|
RA SpA |
33 23 |
12 (36.4%) 12 (52.2%) |
21 (63.6%) 11 (47.8%) |
|
Mean disease duration (mean ± sd) |
|||
|
RA SpA |
14.4 ± 6.8 13.9 ± 6.3 |
18.5±7.9 13.9 ± 7.5 |
12.1 ± 4.9 13.9 ± 5 |
|
Disease activity (mean ± sd) |
|||
|
RA (DAS28) AS (BASDAI) |
2.3 ± 0.5 1.6 ± 1.6 |
2.3 ± 0.3 1.7 ± 1.8 |
2.3 ± 0.6 1.5 ± 1.7 |
|
Antibody Status (RA) |
|||
|
RF ACPA |
28 (85%) 29 (88%) |
9 (75%) 9 (75%) |
19 (90.5%) 20 (95.2%) |
|
Number of positive Ab (RA) |
|||
|
0 1 2 |
4 (12%) 1 (3%) 28 (85%) |
3 (25%) 0 9 (75%) |
1 (4.7%) 1 (4.7%) 19 (90.5%) |
|
Erosive disease (RA) |
24/33 |
9/12 |
15/21 |
|
CRP (mg/dl) (median, IQR) |
|||
|
RA SpA |
0.05 (IQR:0.28) 0.06 (IQR:0.26) |
0.07 (IQR:0.27) 0.03 (IQR:0.17) |
0.05 (IQR:0.28) 0.06 (IQR:0.25) |
|
ESR (median, IQR) |
|||
|
RA SpA |
9 (IQR:6) 10 (IQR:10) |
9 (IQR:5) 7 (IQR:7) |
9 (IQR:9) 12 (IQR: 8) |
|
bDMARD Naive |
|||
|
RA SpA |
28 (85%) 17 (73.9%) |
11 (91.7%) 9 (75%) |
17 (81%) 8 (72.7%) |
|
Concomitant csDMARD |
|||
|
RA SpA |
19 (57.6%) 5 (21.7%) |
7 (58.3%) 1 (8.3%) |
12 (55%) 4 (36.3%) |
|
Concomitant GC |
|||
|
RA SpA |
8 (24.2%) 2 ( 9%) |
2 (16.7%) 0 |
6 (28.6%) 2 (18.2%) |
To cite this abstract in AMA style:
Rodriguez-Garcia SC, Castellanos-Moreira R Sr., Inciarte-Mundo J, Hernández MV, Ruiz-Esquide V, Cuervo A, Ramírez J, Cañete J, Gomez Puerta J, Sanmartí R. Predictors of Persistence of Biologic Drug Step-Down Strategies in Inflammatory Arthritis: An Observational Study in Clinical Practice up to Seven Years of Follow-up [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/predictors-of-persistence-of-biologic-drug-step-down-strategies-in-inflammatory-arthritis-an-observational-study-in-clinical-practice-up-to-seven-years-of-follow-up/. Accessed .« Back to 2018 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/predictors-of-persistence-of-biologic-drug-step-down-strategies-in-inflammatory-arthritis-an-observational-study-in-clinical-practice-up-to-seven-years-of-follow-up/