The algorithm called for patients to receive two-thirds of the standard dose of a biological drug at baseline, half of the standard dose after four months and dose discontinuation after eight months. If a patient experienced a flare (e.g., DAS28 ≥2.6 and DAS28 ≥1.2 since baseline or erosive progression based on imaging), the drug taper was stopped and the dose escalated to the previous dose to regain remission.
Patients included in the study had a DAS ≤2.6 for one year or more, no radiographic progression for one year or more and had not been treated with glucocorticoids within the past six months. Of the 143 patients, most were female (65%) with an average age of 59 years and disease duration of 11 years. Most patients were receiving their first biologic (62%) and were treated with adalimumab (31%), etanercept (28%) or infliximab (27%). Fewer patients were treated with tocilizumab (8%), certolizumab (3%), golimumab (2%) and abatacept (1%).
‘Fifty percent of RA patients in stable, low disease activity while on TNFi can effectively & safely stop TNFi.’ —Dr. Harald Vonkeman
Reporting on the results of the guideline implementation after one year, Dr. Heegaard Brahe said that 66% of the patients received a reduced dose of a biologic.3 Dose reduction was stopped in 101 patients (71%) due to a flare, and all of these patients received escalated doses to regain remission. At one year, 49 patients (34%) had received the full biological dose, 28 (20%) had received two-thirds of a dose, 36 (25%) had received half a dose, and 30 (21%) had discontinued biological treatment.
When assessing potential clinical baseline predictors of flare during the first year, the study found that being female and having longer disease duration were associated with increased risk of flare.
Saying that the study seems to show the feasibility of tapering of biological therapies in RA patients in remission in routine clinical practice, Dr. Heegaard Brahe said the study findings highlighted the “need to identify more predictors for successful tapering and for flare, such as MRI, ultrasound and biomarkers.”
Clinical Predictors of Prolonged Disease Control
Harald Vonkeman, MD, PhD, of the Rheumatology Center Twente, Medisch Spectrum Twente & Twente University, in Enschede, The Netherlands, next presented the results of a substudy of the Dutch national POET study that looked at potential clinical predictors of prolonged disease control after discontinuation of TNFi therapy.4 The study is a multicenter, open-label randomized controlled trial that assessed whether patients with established RA in remission or with stable low disease activity can safely and effectively stop their TNFi therapy.5
