In a nutshell
This study investigated the effectiveness of medication tapering strategies in rheumatoid arthritis (RA).
They found that tapering synthetic or biologic drugs was similarly effective.
Some background
Rheumatoid arthritis (RA) is a long-term immune condition. It is caused by painful swelling in the joints. Disease-modifying anti-rheumatic drugs (DMARDs) are used to treat RA. Synthetic DMARDs (csDMARDs) are chemical drugs. These are the first line of treatment in RA. As RA progresses, patients may also be treated with biological DMARDs (bDMARDs). bDMARDs are antibodies that bind or block immune factors from causing inflammation. Tumor necrosis factor (TNF) inhibitors (TNFi) are a commonly prescribed bDMARD.
The aim of RA treatment is to achieve low disease activity (LDA) or remission (no symptoms). If this is achieved, medication can be reduced. This is called tapering. Long-term use of DMARDs can cause negative side effects. Tapering reduces this. Tapering also reduces the cost of DMARD treatment. It is unclear if tapering csDMARDs or TNFi first is more effective.
Methods & findings
This study included 189 patients with controlled RA. Patients were taking both csDMARDs and a TNFi. Patients were separated into 2 groups. One group underwent csDMARD tapering. The second group underwent TNFi tapering. This was done gradually over 6 months. The main outcome was the number of RA flares at 1 year.
The RA flare rate was 33% in the csDMARD and 43% in the TNFi tapering groups. There was no significant difference in RA flares at 1 year. Joint degeneration had progressed in 5% of csDMARD and 6% of bDMARD patients. Similar rates of side effects were reported in both groups (82 csDMARD, 98 TNFi tapering group).
The bottom line
The authors concluded that tapering synthetic or biologic drugs was similarly effective. They suggested that tapering TNFis first may reduce costs in these patients.
The fine print
This study was relatively short and included a small number of patients. Larger, long-term studies are needed to confirm these findings.
What’s next?
If you have any concerns regarding RA, please consult your physician.
Published By :
Annals of the rheumatic diseases
Date :
Apr 06, 2019
