In a nutshell
This study investigated treatment tapering strategies (TTS) in patients with rheumatoid arthritis (RA). They found that drug-free remission (DFR) can be achieved in a small number of patients.
Some background
Rheumatoid arthritis (RA) is a chronic condition. It is caused by excessive inflammation. This leads to painful swelling in the joints. RA is treated with disease-modifying anti-rheumatic drugs (DMARDs). DMARDs target inflammation. This reduces disease activity (DA). Most patients take several types of DMARDs
The aim of DMARD treatment is to achieve remission. This is when DA is low and the disease is not progressing. Drug tapering can be considered if this happens. Tapering involves reducing medication. There are many reasons a patient may want this. Some of the most common reasons are to prevent ongoing side effects and cost. Tapering is usually done with one drug at a time. The ideal treatment tapering strategy (TTS) has not been identified. It is unclear if a TTS can be safe and effective in RA.
Methods & findings
This study included 189 patients with RA. These patients were taking a synthetic DMARD (csDMARD) such as methotrexate (Otrexup). They were also taking a tumor necrosis factor inhibitor (TNFi). TNFis are biological DMARDs (bDMARD) such as adalimumab (Humira), etanercept (Enbrel), certolizumab (Cimzia), and golimumab (Simponi). Patients were randomly assigned to taper either csDMARD or TNFi first. A follow-up assessment was performed at 2 years. The main outcomes were DA flares (DAF).
After 2 years, the average DAF rates were similar in both groups (61% – csDMARD vs. 62% TNFi). 31% of the patients that tapered csDMARDs first progressed to TNFi tapering. 20% of patients that tapered TNFi first progressed to csDMARD tapering. None of these patients had a flare 18-24 months after tapering both types of drugs.
DFR was achieved by 15% of all patients. 20% of the patients who tapered csDMARDs first and 11% of those who tapered TNFis first achieved DFR after 24 months.
The bottom line
The authors concluded that both TTS had similar outcomes. However, due to higher costs, the authors suggest that tapering TNFis first might be more cost-effective.
The fine print
The long-term safety of TTS is unclear. Patients in this study were not in deep remission. This means that TTS may have different outcomes in these patients. Also, patients were on more than one csDMARD. The tapering strategy involved only one drug. Further long-term studies are needed.
Published By :
Annals of the rheumatic diseases
Date :
Jun 01, 2020
