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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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@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