New research presented at the 2017 annual meeting of the American College of Rheumatology (ACR) and the Association of Rheumatology Health Professionals (ARHP) shows that certain factors make some patients with rheumatoid arthritis (RA) more likely to have success tapering biologic disease-modifying antirheumatic drugs (DMARDs).
Although DMARDs are effective in treating RA, they are associated with high costs and can lead to dose-dependent adverse effects. Therefore, patients in sustained remission may choose to taper treatment, but healthcare professionals don’t have much guidance regarding what strategies work best for individual patients.
“Biologic DMARD tapering seems to be a feasible approach, and it is widely used in clinical practice, but a significant proportion of patients experience relapse. It is important for rheumatologists to know the clinical characteristics of patients who might successfully maintain remission after down-titration,” said Takaaki Komiya, MD, a researcher at Yokohama City University Graduate School of Medicine in Japan and a lead author in the study.
To identify specific factors that might predict successful down-titration or determine the most effective lower dose, Dr. Komiya and colleagues examined a retrospective cross-section of RA patients. They found that younger patients, those not using steroids, and those with lower levels of serum C-reactive protein (CRP) were more likely to taper DMARDs successfully.
The researchers enrolled 347 patients with RA from two university hospitals in Japan. To be included, patients had to fulfill the 1987 ACR and/or 2010 ACR/EULAR classification criteria and had to have been treated with infliximab, adalimumab, etanercept, golimumab, certolizumab-pegol, tocizilumab, or abatacept for longer than six months. The sample had a mean age of 62.5 years, had a mean disease duration of 12.3 years, and was mostly female (83.6 percent).
Patients were divided into two groups: 255 patients were on a stable treatment, and 92 were tapered. The two groups had similar baseline disease activity, but the researchers observed several significant differences:
- Patients who were successfully tapered were younger at disease onset (mean age of 47.1 versus 51).
- Tapered patients were also younger when they started biologics (mean age of 55.5 versus 59.6).
- Patients with no concomitant use of oral corticosteroids and low levels of CRP were more likely to successfully taper.