Withdrawal of Nonsteroidal Anti-Inflammatory Drugs in Rheumatoid Arthritis Patients with Low Disease Activity

Dong Jin Go^1,2, Kichul Shin³, Han Joo Baek⁴, Seong-Wook Kang⁵, Young Mo Kang⁶, Jae-Bum Jun⁷, Yun Jong Lee⁸, Sung-Hwan Park⁹ and Yeong Wook Song^10,11, ¹Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea, The Republic of, ²Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea, The Republic of, ³Division of Rheumatology, Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea, ⁴Division of Rheumatology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, South Korea, ⁵Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, South Korea, ⁶Division of Rheumatology, Department of Internal Medicine, Kyungpook National University Hospital, Daegu, South Korea, ⁷Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea, The Republic of, ⁸Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea, ⁹Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, South Korea, ¹⁰Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea, ¹¹Department of Molecular Medicine and Biopharmaceutical Sciences, BK21 plus Graduate School of Convergence Science and Technology, and College of Medicine or College of Pharmacy, Seoul National University, Seoul, South Korea

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: Disease Activity, Nonsteroidal antiinflammatory drugs (NSAIDs), pain management and rheumatoid arthritis (RA)

Session Information

Date: Tuesday, November 15, 2016

Title: Rheumatoid Arthritis – Small Molecules, Biologics and Gene Therapy - Poster III

Session Type: ACR Poster Session C

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

Background/Purpose: Although nonsteroidal anti-inflammatory drugs (NSAIDs) are effective in relieving joint pain in rheumatoid arthritis (RA) patients, long-term use of NSAIDs can cause adverse effects. We aimed to examine the patient-reported outcome (PRO) and its associated clinical factors in RA patients with low disease activity (LDA) after discontinuing NSAIDs.

Methods: This study was a 16-week, multi-center prospective open-label trial. RA patients who achieved LDA (28-joint Disease Activity Score [DAS28] < 3.2) who were on NSAIDs for more than a month discontinued the NSAIDs. Acetaminphen (AAP) was used as the rescue medication. Changes of DAS28 and PRO including pain visual analogue scale (pain-VAS) and Routine Assessment of Patient Index Data 3 (RAPID-3) score were assessed. NSAID was restarted when patient’s pain was intolerable with AAP. The endpoint was to analyze the group of patients who continued to withdraw NSAID. Patients were further classified to have “sustained effectiveness” who met the following: 1) pain-VAS ≤30 mm at week16 or increase less than 25% from baseline and 2) RAPID-3 score ≤6 at week16 or increase less than 25% from baseline.

Results: A total of 109 RA patients with LDA were enrolled in the study. At the end of the study, 89 (84.8%) patients had remained without restarting NSAID. In these patients, there was a difference in pain-VAS between baseline and week 16 (P= 0.010). However, changes in RAPID-3 and DAS28 were insignificant (P= 0.128 for RAPID-3 and P= 0.638 for DAS28) Moreover, 66 patients ended up to show sustained effectiveness without restarting NSAID. After adjustments of covariables, we found out joint swelling was the detrimental factor in NSAID withdrawal (odd ratio [OR] 0.150, 95% confidence interval [CI] 0.034-0.666, P= 0.013) and sustained effectiveness (OR 0.312, 95% CI 0.101-0.964, P= 0.043).

Conclusion: NSAIDs can be attempted to discontinue in RA patients with LDA, especially in patients without joint swelling.

Disclosure: D. J. Go, None; K. Shin, None; H. J. Baek, None; S. W. Kang, None; Y. M. Kang, None; J. B. Jun, None; Y. J. Lee, None; S. H. Park, None; Y. W. Song, None.

To cite this abstract in AMA style:

Go DJ, Shin K, Baek HJ, Kang SW, Kang YM, Jun JB, Lee YJ, Park SH, Song YW. Withdrawal of Nonsteroidal Anti-Inflammatory Drugs in Rheumatoid Arthritis Patients with Low Disease Activity [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/withdrawal-of-nonsteroidal-anti-inflammatory-drugs-in-rheumatoid-arthritis-patients-with-low-disease-activity/. Accessed .

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