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

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningfagfællebedømt

  • Cecilie Heegaard Brahe
  • Simon Krabbe
  • Lykke Ørnbjerg
  • Daniel Glinatsi
  • Henrik Røgind
  • Hanne S. Jensen
  • Annette Hansen
  • Jesper Nørregaard
  • Tuan K. Huynh
  • Dorte V. Jensen
  • Natalia Manilo
  • Karsten Asmussen
  • Per Brown Frandsen
  • Zoreh Rastiemadabadi
  • Lone Morsel Carlsen
  • Jakob M. Møller
  • Niels S. Krogh

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.

Udgave nummer1
Sider (fra-til)110-119
StatusUdgivet - 2019

ID: 222707115