Biologic Tapering Successful, Cost-effective in Low-activity RA
CHICAGO — Patients with rheumatoid arthritis who achieve low disease activity can successfully taper their biologic drugs, saving them money, according to data presented by Patrick Durez, MD, of the Catholic University of Louvain, Belgium.
“Biologic treatment has totally changed the treatment of rheumatoid arthritis, and it has been used for the past 20 years,” Durez told attendees at the ACR/ARHP 2018 Annual Meeting. “Several studies have demonstrated that tapering the biologic treatment in patients who achieve low disease activity is successful. There are studies, including the present study, which demonstrate that we can decrease the dose of etanercept from 50 mg to 25 mg without losing the disease control.”
To analyze the proportion of patients for whom biologic disease-modifying antirheumatic drugs can be tapered in daily clinical practice — as well as to evaluate the characteristics of patients who taper and determine which biologics are more easily reduced — Durez and colleagues studied data from 332 patients with RA from the Catholic University of Louvain. All patients included in the study were treated with a biologic DMARD for at least 1 year. Senior physicians recommended dose reductions in cases when a patient achieved low disease activity or remission. In addition, the researchers collected data on patient characteristics and baseline data prior to biologic initiation.
Among the patients included in the study, 140 tapered their biologic DMARD regimen, while 192 received full doses. In the tapered group, 86.7% of patients demonstrated concomitant methotrexate use, compared with 73.8% in the full-dose cohort. There were no differences between the groups regarding gender, anti-citrullinated protein antibody (ACPA), erosions, the number of previous biologic DMARDs, the time to first conventional synthetic DMARD and biologic DMARD, baseline Disease Activity Score 28 and C-Reactive Protein (DAS28-CRP) and glucocorticoid use.
According to Durez, Health Assessment Questionnaire scores were lower in the tapering group compared to the full-dose group. In addition, current DAS28-CRP scores were lower in the tapered group. Fifteen patients experienced a flare during the follow-up period. Anti-TNF drugs were the most commonly prescribed biologics reported in the study. Adalimumab (Humira, AbbVie), etanercept (Enbrel, Amgen) and rituximab (Rituxan, Genentech) were the most frequently tapered biologics, and were also associated with the most significant reductions in annual cost for patients.
“In daily practice, the tapering of biologics in rheumatoid arthritis is feasible when low disease activity or remission is achieved, and we should certainly promote the biologics to do this,” Durez said. “The patient would be open to this, because it would reduce the number of side effects, and they sometimes do taper by themselves. The combination with methotrexate is probably one important predictive factor to initiate tapering the dose regimen, but we need further research.” – by Jason Laday
Disclosure: Durez reports no relevant financial disclosures.
Durez P. Abstract 625. Presented at ACR/ARHP Annual Meeting, Oct. 20-24, 2018; Chicago.