Tapering of biological antirheumatic drugs in rheumatoid arthritis patients is achievable and cost-effective in daily clinical practice: data from the Brussels UCLouvain RA Cohort

Abstract

Background/purpose Studies have demonstrated that rheumatoid arthritis (RA) patients who achieve low disease activity or remission are able to taper biological disease-modifying antirheumatic drugs (bDMARDs). The aim of this study was to evaluate the proportion of patients in whom bDMARDs can be tapered in daily practice and to analyse the characteristics of these patients. Other objectives were to analyse which bDMARDs are more suitable for dose reduction and the cost savings. Results Data from 332 eligible RA patients from our Brussels UCLouvain cohort were retrospectively analysed; 140 patients (42.1%) received a tapered regimen, and 192 received stable doses of bDMARDs. The age at diagnosis (43.1 vs 38.7 years, p = 0.04), health assessment questionnaire (HAQ) score (1.3 vs 1.5, p = 0.048), RF positivity rate (83.3 vs 72.9%, p = 0.04) and disease duration at the time of bDMARD introduction (9.7 vs 12.1 years, p = 0.034) were significantly different between the reduced-dose and stable-dose groups. Interestingly, relatively more patients receiving a tapered dose were treated with a combination of bDMARDs and methotrexate (MTX) (86.7% vs 73.8%, p = 0.005). In our cohort, anti-TNF agents were the most commonly prescribed medications (68%). Only 15 patients experienced a flare during follow-up. Adalimumab, etanercept and rituximab were the most common bDMARDs in the reduced-dose group and were associated with the most important reductions in annual cost. Conclusion In daily practice, tapering bDMARDs in RA patients who have achieved low disease activity or remission is an achievable goal in a large proportion of patients, thereby reducing potential side effects and annual drug-associated costs. The combination of bDMARDs with MTX could improve the success of dose reduction attempts. Trial registration This retrospective non-interventional study was retrospectively registered with local ethics approval.

Discontinuation of biologic DMARDs in non-systemic JIA patients: a scoping review of relapse rates and associated factors

“…Reducing or stopping bDMARDs (when disease activity is low) might therefore be a valuable strategy to reduce side effects (in particular infections) and costs. Dose reduction in adult population of rheumatoid arthritis (RA) patients has been proven to be successful, yet discontinuation is not recommended, as many adult RA patient flare after discontinuation [9][10][11][12][13]. However, some JIA patients may recover spontaneously, with studies reporting over 50% of patients being in clinical remission off medication, 30 years after disease onset.…”

Patient and rheumatologist perspectives on tapering DMARDs in rheumatoid arthritis: a qualitative study

“…Current guidelines recommend tapering of biologic therapy for patients who are in sustained remission [7,8], and emerging evidence suggests tapering of conventional synthetic (cs) DMARDs may also be possible in some patients [9]. While tapering of biologic therapy in clinical practice has been successful when systematically offered to patients [10], tapering in routine care is uncommon and often involves nonbiologic therapy [11]. This may stem from a challenge in identifying which patients are suitable for a reduction in treatment.…”

Tapering of biological treatment in autoinflammatory diseases: a scoping review

“…There is evidence in rheumatic inflammatory diseases, that inactive disease may be sustained with lower drug concentrations than needed to treat active disease [ 33 , 34 ]. Furthermore, gradual tapering yields inactive disease, and will reduce potential risk for adverse events and costs [ 35 , 36 ]. However, how to taper most effectively remains uncertain.…”