Dose tapering and discontinuation of biological therapy in rheumatoid arthritis patients in routine care: 2-year outcomes and predictors
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Dose tapering and discontinuation of biological therapy in rheumatoid arthritis patients in routine care : 2-year outcomes and predictors. / 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; Carlsen, Lone Morsel; Møller, Jakob M.; Krogh, Niels S.; Hetland, Merete Lund.
I: Rheumatology, Bind 58, Nr. 1, 2019, s. 110-119.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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T1 - Dose tapering and discontinuation of biological therapy in rheumatoid arthritis patients in routine care
T2 - 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 - Carlsen, Lone Morsel
AU - Møller, Jakob M.
AU - Krogh, Niels S.
AU - Hetland, Merete Lund
PY - 2019
Y1 - 2019
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-CRP51.2 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-CRP51.2 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 - bDMARD
KW - Biomarkers
KW - Prediction
KW - RA
KW - Radiographic progression
KW - Remission
KW - Successful dose tapering
KW - Tapering
U2 - 10.1093/rheumatology/key244
DO - 10.1093/rheumatology/key244
M3 - Journal article
C2 - 30169706
AN - SCOPUS:85059290377
VL - 58
SP - 110
EP - 119
JO - Rheumatology
JF - Rheumatology
SN - 1462-0324
IS - 1
ER -
ID: 222707115