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
SN - 1462-0332
VL - 58
SP - 110
EP - 119
JO - Rheumatology (Oxford, England)
JF - Rheumatology (Oxford, England)
IS - 1
ER -