Paradigm guiding to tapering or discontinuation of biologic and targeted synthetic disease‐modifying antirheumatic drugs in the treatment of patients with rheumatoid arthritis: Results from a local prospective study

Author:

Kaban Nedim1,Harman Halil2ORCID

Affiliation:

1. Department of Rheumatology Çanakkale Mehmet Akif Ersoy State Hospital Çanakkale Turkey

2. Department of Rheumatology University of Health Sciences, İstanbul Physical Medicine and Rehabilitation Education and Research Hospital İstanbul Turkey

Abstract

AbstractObjectiveWe prospectively conduct the current study to figure out predicting factors whether biologic and targeted synthetic disease‐modifying antirheumatic drugs (b/tsDMARDs) can be discontinued or tapered in patients with rheumatoid arthritis (RA).Materials and MethodsThe study population encompassed 126 consecutive RA patients on b/tsDMARDs for at least 1 year. Remission was defined as a Disease Activity Score of 28 joints (DAS28) ‐ erythrocyte sedimentation rate <2.6. The b/tsDMARD dosing interval was increased in patients in remission for at least 6 months. In patients in whom the b/tsDMARD dosing interval could be increased by 100% for at least 6 months, the b/tsDMARD was stopped at the end of this period. Disease relapse was defined as deterioration from remission to moderate or high disease activity.ResultsThe mean duration of b/tsDMARD treatment for all patients was 2.54 ± 1.55 years. Logistic regression analysis did not identify any independent predictor of treatment discontinuation. Independent predictors for tapering in b/tsDMARD treatment are no switch to another therapy and lower baseline DAS28 scores (respectively, P = .029, .024). Time to relapse after tapering was shorter in patients requiring corticosteroids when the 2 groups were compared with the log‐rank test (2.83 vs 10.8 months; P = .05).ConclusionIt seems a reasonable approach to consider b/tsDMARD tapering in patients with remission period of >3.5 months, lower baseline DAS28 scores and without requiring corticosteroid use. Unfortunately, no predictor has been found to predict b/tsDMARD discontinuation.

Publisher

Wiley

Subject

Rheumatology

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