Study Explores Factors That Predict RA Candidates for Successful DMARD Tapering

Certain factors contribute to the likelihood that patients whose rheumatoid arthritis (RA) is in remission may be more successful in tapering their biologic drugs, according to new research presented at the 2017 American College of Rheumatology’s Annual Meeting, being held November 3 to 8 in San Diego, California.

Researchers from Japan presented their findings at the meeting that patients who are younger, have no concomitant steroid use, and have a low level of serum C-reactive protein (CRP) are better candidates for tapering their dose of biologic disease-modifying antirheumatic drugs (DMARDs). The researchers strove to better understand the process of tapering in the real-world setting, and to identify in which patients tapering would be most successful.

Patients with RA who are in sustained remission may prefer to taper their biologic DMARD dose because, while these treatments are effective in treating RA, they are expensive and are associated with dose-dependent adverse effects, explained Takaaki Komiya, MD, a researcher at Yokohama City University Graduate School of Medicine and a lead author of the study.

“Biologic DMARD tapering seems to be a feasible approach and it is widely used in clinical practice, but a significant proportion of patients experience relapse,” Komiya said in a statement. “It is important for rheumatologists to know the clinical characteristics of patients who might successfully maintain remission after down-titration.”

The study included 347 patients with RA from 2 university hospitals in Japan. The patients were treated with one of the following biologics for at least 6 months: infliximab, adalimumab, etenercept, golimumab, certolizumab-pegol, tocizilumab, or abatacept. The patients had a mean age of 62.5 years, mean disease duration of 12.3 years, and were mostly female (83.6%).

Of the total number of participants, 255 patients were put into the group on stable treatment and 92 patients were put into the group with tapered treatment. Baseline disease activity was similar for both groups. The researchers noticed that the patients who were successfully tapered were younger at disease onset and at the time when they started using biologics. Patients who were biologic-DMARD naïve were more likely to successfully taper, as were those with no concomitant use of oral corticosteroids and low levels of CRP.

“An important strength is that this study reflects the real-world experience,” said Komiya. “The results of this preliminary study may help rheumatologists to differentiate RA patients who would successfully down-titrate biologics. This management might result in substantial reduction in costs and possible reduction in dose-dependent side effects.”