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Dose tapering and discontinuation of biological therapy in rheumatoid arthritis patients in routine care - 2-year outcomes and predictors

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Harvard

Brahe, CH, Krabbe, S, Østergaard, M, Ørnbjerg, L, Glinatsi, D, Røgind, H, Jensen, HS, Hansen, A, Nørregaard, J, Jacobsen, S, Terslev, L, Huynh, TK, Jensen, DV, Manilo, N, Asmussen, K, Frandsen, PB, Boesen, M, Rastiemadabadi, Z, Morsel Carlsen, L, Møller, JM, Krogh, NS & Hetland, ML 2019, 'Dose tapering and discontinuation of biological therapy in rheumatoid arthritis patients in routine care - 2-year outcomes and predictors', Rheumatology (Oxford, England), vol. 58, no. 1, pp. 110-119. https://doi.org/10.1093/rheumatology/key244

APA

Brahe, C. H., Krabbe, S., Østergaard, M., Ørnbjerg, L., Glinatsi, D., Røgind, H., Jensen, H. S., Hansen, A., Nørregaard, J., Jacobsen, S., Terslev, L., Huynh, T. K., Jensen, D. V., Manilo, N., Asmussen, K., Frandsen, P. B., Boesen, M., Rastiemadabadi, Z., Morsel Carlsen, L., ... Hetland, M. L. (2019). Dose tapering and discontinuation of biological therapy in rheumatoid arthritis patients in routine care - 2-year outcomes and predictors. Rheumatology (Oxford, England), 58(1), 110-119. https://doi.org/10.1093/rheumatology/key244

CBE

Brahe CH, Krabbe S, Østergaard M, Ørnbjerg L, Glinatsi D, Røgind H, Jensen HS, Hansen A, Nørregaard J, Jacobsen S, Terslev L, Huynh TK, Jensen DV, Manilo N, Asmussen K, Frandsen PB, Boesen M, Rastiemadabadi Z, Morsel Carlsen L, Møller JM, Krogh NS, Hetland ML. 2019. Dose tapering and discontinuation of biological therapy in rheumatoid arthritis patients in routine care - 2-year outcomes and predictors. Rheumatology (Oxford, England). 58(1):110-119. https://doi.org/10.1093/rheumatology/key244

MLA

Vancouver

Author

Brahe, Cecilie Heegaard ; Krabbe, Simon ; Østergaard, Mikkel ; Ørnbjerg, Lykke ; Glinatsi, Daniel ; Røgind, Henrik ; Jensen, Hanne S ; Hansen, Annette ; Nørregaard, Jesper ; Jacobsen, Søren ; Terslev, Lene ; Huynh, Tuan K ; Jensen, Dorte V ; Manilo, Natalia ; Asmussen, Karsten ; Frandsen, Per Brown ; Boesen, Mikael ; Rastiemadabadi, Zoreh ; Morsel Carlsen, Lone ; Møller, Jakob M ; Krogh, Niels S ; Hetland, Merete Lund. / Dose tapering and discontinuation of biological therapy in rheumatoid arthritis patients in routine care - 2-year outcomes and predictors. In: Rheumatology (Oxford, England). 2019 ; Vol. 58, No. 1. pp. 110-119.

Bibtex

@article{e772eea4a1a04bf79b1f1464771ef23b,
title = "Dose tapering and discontinuation of biological therapy in rheumatoid arthritis patients in routine care - 2-year outcomes and predictors",
abstract = "Objectives: A cohort of routine care RA patients in sustained remission had biological DMARD (bDMARDs) tapered according to a treatment guideline. We studied: the proportion of patients whose bDMARD could be successfully tapered or discontinued; unwanted consequences of tapering/discontinuation; and potential baseline predictors of successful tapering and discontinuation.Methods: One-hundred-and-forty-three patients (91% receiving TNF inhibitor and 9% a non-TNF inhibitor) with sustained disease activity score (DAS28-CRP)⩽2.6 and no radiographic progression the previous year were included. bDMARD was reduced to two-thirds of standard dose at baseline, half after 16 weeks, and discontinued after 32 weeks. Patients who flared (defined as either DAS28-CRP ⩾ 2.6 and ΔDAS28-CRP ⩾ 1.2 from baseline, or erosive progression on X-ray and/or MRI) stopped tapering and were escalated to the previous dose level.Results: One-hundred-and-forty-one patients completed 2-year follow-up. At 2 years, 87 patients (62%) had successfully tapered bDMARDs, with 26 (18%) receiving two-thirds of standard dose, 39 (28%) half dose and 22 (16%) having discontinued; and 54 patients (38%) were receiving full dose. ΔDAS28-CRP0-2yrs was 0.1((-0.2)-0.4) (median (interquartile range)) and mean ΔTotal-Sharp-Score0-2yrs was 0.01(1.15)(mean(s.d.)). Radiographic progression was observed in nine patients (7%). Successful tapering was independently predicted by: ⩽1 previous bDMARD, male gender, low baseline MRI combined inflammation score or combined damage score. Negative IgM-RF predicted successful discontinuation.Conclusion: By implementing a clinical guideline, 62% of RA patients in sustained remission in routine care were successfully tapered, including 16% successfully discontinued at 2 years. Radiographic progression was rare. Maximum one bDMARDs, male gender, and low baseline MRI combined inflammation and combined damage scores were independent predictors for successful tapering.",
keywords = "Aged, Antirheumatic Agents/administration & dosage, Arthritis, Rheumatoid/diagnostic imaging, Biological Products/administration & dosage, Disease Progression, Female, Humans, Induction Chemotherapy, Magnetic Resonance Imaging, Male, Middle Aged, Radiography, Recurrence, Severity of Illness Index, Symptom Flare Up, Time Factors, Treatment Outcome, Withholding Treatment",
author = "Brahe, {Cecilie Heegaard} and Simon Krabbe and Mikkel {\O}stergaard and Lykke {\O}rnbjerg and Daniel Glinatsi and Henrik R{\o}gind and Jensen, {Hanne S} and Annette Hansen and Jesper N{\o}rregaard and S{\o}ren Jacobsen and Lene Terslev and Huynh, {Tuan K} and Jensen, {Dorte V} and Natalia Manilo and Karsten Asmussen and Frandsen, {Per Brown} and Mikael Boesen and Zoreh Rastiemadabadi and {Morsel Carlsen}, Lone and M{\o}ller, {Jakob M} and Krogh, {Niels S} and Hetland, {Merete Lund}",
note = "COPECARE",
year = "2019",
month = jan,
day = "1",
doi = "10.1093/rheumatology/key244",
language = "English",
volume = "58",
pages = "110--119",
journal = "Rheumatology (Online)",
issn = "1462-0332",
publisher = "Oxford University Press",
number = "1",

}

RIS

TY - JOUR

T1 - Dose tapering and discontinuation of biological therapy in rheumatoid arthritis patients in routine care - 2-year outcomes and predictors

AU - Brahe, Cecilie Heegaard

AU - Krabbe, Simon

AU - Østergaard, Mikkel

AU - Ørnbjerg, Lykke

AU - Glinatsi, Daniel

AU - Røgind, Henrik

AU - Jensen, Hanne S

AU - Hansen, Annette

AU - Nørregaard, Jesper

AU - Jacobsen, Søren

AU - Terslev, Lene

AU - Huynh, Tuan K

AU - Jensen, Dorte V

AU - Manilo, Natalia

AU - Asmussen, Karsten

AU - Frandsen, Per Brown

AU - Boesen, Mikael

AU - Rastiemadabadi, Zoreh

AU - Morsel Carlsen, Lone

AU - Møller, Jakob M

AU - Krogh, Niels S

AU - Hetland, Merete Lund

N1 - COPECARE

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objectives: A cohort of routine care RA patients in sustained remission had biological DMARD (bDMARDs) tapered according to a treatment guideline. We studied: the proportion of patients whose bDMARD could be successfully tapered or discontinued; unwanted consequences of tapering/discontinuation; and potential baseline predictors of successful tapering and discontinuation.Methods: One-hundred-and-forty-three patients (91% receiving TNF inhibitor and 9% a non-TNF inhibitor) with sustained disease activity score (DAS28-CRP)⩽2.6 and no radiographic progression the previous year were included. bDMARD was reduced to two-thirds of standard dose at baseline, half after 16 weeks, and discontinued after 32 weeks. Patients who flared (defined as either DAS28-CRP ⩾ 2.6 and ΔDAS28-CRP ⩾ 1.2 from baseline, or erosive progression on X-ray and/or MRI) stopped tapering and were escalated to the previous dose level.Results: One-hundred-and-forty-one patients completed 2-year follow-up. At 2 years, 87 patients (62%) had successfully tapered bDMARDs, with 26 (18%) receiving two-thirds of standard dose, 39 (28%) half dose and 22 (16%) having discontinued; and 54 patients (38%) were receiving full dose. ΔDAS28-CRP0-2yrs was 0.1((-0.2)-0.4) (median (interquartile range)) and mean ΔTotal-Sharp-Score0-2yrs was 0.01(1.15)(mean(s.d.)). Radiographic progression was observed in nine patients (7%). Successful tapering was independently predicted by: ⩽1 previous bDMARD, male gender, low baseline MRI combined inflammation score or combined damage score. Negative IgM-RF predicted successful discontinuation.Conclusion: By implementing a clinical guideline, 62% of RA patients in sustained remission in routine care were successfully tapered, including 16% successfully discontinued at 2 years. Radiographic progression was rare. Maximum one bDMARDs, male gender, and low baseline MRI combined inflammation and combined damage scores were independent predictors for successful tapering.

AB - Objectives: A cohort of routine care RA patients in sustained remission had biological DMARD (bDMARDs) tapered according to a treatment guideline. We studied: the proportion of patients whose bDMARD could be successfully tapered or discontinued; unwanted consequences of tapering/discontinuation; and potential baseline predictors of successful tapering and discontinuation.Methods: One-hundred-and-forty-three patients (91% receiving TNF inhibitor and 9% a non-TNF inhibitor) with sustained disease activity score (DAS28-CRP)⩽2.6 and no radiographic progression the previous year were included. bDMARD was reduced to two-thirds of standard dose at baseline, half after 16 weeks, and discontinued after 32 weeks. Patients who flared (defined as either DAS28-CRP ⩾ 2.6 and ΔDAS28-CRP ⩾ 1.2 from baseline, or erosive progression on X-ray and/or MRI) stopped tapering and were escalated to the previous dose level.Results: One-hundred-and-forty-one patients completed 2-year follow-up. At 2 years, 87 patients (62%) had successfully tapered bDMARDs, with 26 (18%) receiving two-thirds of standard dose, 39 (28%) half dose and 22 (16%) having discontinued; and 54 patients (38%) were receiving full dose. ΔDAS28-CRP0-2yrs was 0.1((-0.2)-0.4) (median (interquartile range)) and mean ΔTotal-Sharp-Score0-2yrs was 0.01(1.15)(mean(s.d.)). Radiographic progression was observed in nine patients (7%). Successful tapering was independently predicted by: ⩽1 previous bDMARD, male gender, low baseline MRI combined inflammation score or combined damage score. Negative IgM-RF predicted successful discontinuation.Conclusion: By implementing a clinical guideline, 62% of RA patients in sustained remission in routine care were successfully tapered, including 16% successfully discontinued at 2 years. Radiographic progression was rare. Maximum one bDMARDs, male gender, and low baseline MRI combined inflammation and combined damage scores were independent predictors for successful tapering.

KW - Aged

KW - Antirheumatic Agents/administration & dosage

KW - Arthritis, Rheumatoid/diagnostic imaging

KW - Biological Products/administration & dosage

KW - Disease Progression

KW - Female

KW - Humans

KW - Induction Chemotherapy

KW - Magnetic Resonance Imaging

KW - Male

KW - Middle Aged

KW - Radiography

KW - Recurrence

KW - Severity of Illness Index

KW - Symptom Flare Up

KW - Time Factors

KW - Treatment Outcome

KW - Withholding Treatment

U2 - 10.1093/rheumatology/key244

DO - 10.1093/rheumatology/key244

M3 - Journal article

C2 - 30169706

VL - 58

SP - 110

EP - 119

JO - Rheumatology (Online)

JF - Rheumatology (Online)

SN - 1462-0332

IS - 1

ER -

ID: 59267888