In a nutshell
This study investigated if reducing the doses (tapering) of biologic drugs maintains effectiveness in patients with rheumatoid arthritis (RA).
They found that drug tapering maintained low disease activity (LDA) and remission while reducing side effects and costs.
Some background
Rheumatoid arthritis (RA) is a chronic condition. It is caused by painful inflammation in the joints. Disease-modifying anti-rheumatic drugs (DMARDs) are used to treat RA. The aim of RA treatment is to reach low disease activity (LDA) or remission. LDA is when symptoms are minimial. Remission is when the disease is not progressing.
Biological DMARDs (bDMARDs) are antibodies. They target specific chemicals or receptors to reduce inflammation. bDMARDs are very effective. However, they also have side effects. They are also expensive. Some studies suggest that tapering bDMARDs can be done when LDA or remission was achieved. Tapering is when you reduce the dose of a drug and maintain effectiveness. It is unclear if tapering bDMARDs maintains LDA/remission in RA.
Methods & findings
This study included 332 patients with RA. All patients had sustained LDA or remission for 6 months. There were two patient groups. One group maintained the same bDMARD dose (stable dose). The second group received a reduced bDMARD dose. The main outcome was disease activity (DA). This included the DA score (DAS28-CRP) which measures joint inflammation.
More patients in the reduced dose group were also treated with methotrexate. At the start of this study DAS28-CRP scores were similar between the groups. DAS28-CRP scores were higher (meaning higher DA) in the stable dose group at the end of this study. The annual cost of treatment was reduced by 15%-50% in the reduced dose group.
The bottom line
The authors concluded that biological drug tapering maintained LDA and remission, while reducing costs in patients with RA.
The fine print
The type of bDMARD varied between patients. The study was based on medical records. Information might have been missing. A randomized controlled study is needed to determine if tapering is effective for all patients with LDA/remission.
What’s next?
If you have any concerns regarding RA management please consult with your doctor.
Published By :
Arthritis Research & Therapy
Date :
Apr 28, 2020
