San Diego—What are the factors that signal more success for rheumatoid arthritis (RA) patients who seek to taper off their biologic medications?
A presentation at the recent 2017 American College of Rheumatology/Association of Rheumatology Health Professionals (ACR/ARHP) Annual Meeting in San Diego offered some answers to that question.
Japanese researchers report that RA patients in remission might experience more successful tapering of their biologic drugs if they are:
• Of younger age
• Have no concomitant steroid use
• Have a low level of serum CRP
In an effort to determine predictive factors leading to successful down-titration of biologic DMARDs, Yokohama City University Graduate School of medicine researchers analyzed a retrospective cross-section of RA patients.
“Biologic DMARDs are effective in treating patients with RA, but they are associated with high costs and dose-dependent adverse effects,” noted lead author Takaaki Komiya. “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. It is important for rheumatologists to know the clinical characteristics of patients who might successfully maintain remission after down-titration.”
The study included 347 RA patients from two university hospitals in Japan. Participants met the 1987 ACR and/or 2010 ACR/EULAR classification criteria and were treated for longer than 6 months with one of the following biologics: infliximab, adalimumab, etanercept, golimumab, certolizumab-pegol, tocizilumab, or abatacept.
The patients, with a mean age of 62.5 years, were predominately—83.6%—female, and had a mean disease duration of 12.3 years. With 255 patients on stable treatment, 92 patients were tapered. To access the effects, the researchers assessed laboratory data and x-ray images.
The two groups were similar in terms of baseline disease activity, prevalence of anticitrullinated protein antibody and rheumatoid factor, and x-ray findings. Yet some significant differences were recognized.
Results indicated that patients who were successfully tapered were both younger at disease onset—with a mean age of 47.1 versus 51 in the stable treatment group—and at the point that they initiated biologics—mean age 55.5 versus 59.6 in the stable treatment group.
In addition, 74% of the patients who were successfully tapered were biologic-DMARD naïve compared with 56% in the stable treatment group. Successful tapering also was more likely to occur in patients with no concomitant use of oral corticosteroids and low levels of C-reactive protein.
“An important strength is that this study reflects the ‘real world’ experience,” Komiya said. “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.”