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Tapering TNFi dose by 33% did not affect RA flares
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In patients with rheumatoid arthritis treated with tumor necrosis factor inhibitors, dose tapering by 33% did not appear to diminish clinical response and appeared to be a reasonable option for patients in sustained remission, according to findings from the OPTTIRA trial.
Researchers evaluated patients with rheumatoid arthritis (RA) and who achieved favorable responses, including low disease activity or remission, from treatment with tumor necrosis factor inhibitor (TNFi) medications (etanercept or adalimumab) at standard doses and one or more disease-modifying antirheumatic drugs. Sustained good responses were defined as DAS28 of less than 3.2 without increases of greater than 0.6 for 3 months. Time to first flare was the primary outcome of the study.
Of the 240 patients initially screened for analysis, 103 were randomized and 97 were treated. Of these 97 patients, 50 were randomized to the control group; 26 were randomized to tapering of TNFi by 33%; and 21 were randomized to 66% TNFi tapering. A total of 74 patients completed 6 months of treatment.
Researchers found that during months 0 to 6, eight flares (16%) occurred in the control group (n=50), three flares (12%) occurred in the 33% tapering group (n=26) and six flares (29%) occurred in the 66% tapering group (n=21). In multivariate Cox analysis, it was revealed that 33% tapering did not alter the time to flare vs. controls, but 66% tapering shortened the time to flare vs. controls (adjusted HR: 2.81).
The exploratory phase of the study revealed that the 33% tapering group had 6/48 (13%) flares, while the 66% tapering group had 14/39 flares (36%). Multivariate analysis found 66% tapering shortened time to flare (adjusted HR: 3.47).
“We consider there is sufficient evidence for clinicians to reduce TNF inhibitor doses in some treatment responders,” the researchers wrote. “This approach may be more cost-effective than their continued use, though it risks short-term disadvantages, as flares are a burden to patients. Its impacts on disease status and health care costs need further evaluation, particularly as we found no evidence that tapering worsened patient-assessed outcomes.” -by Jennifer Byrne
Disclosure: One of the authors reports receiving speaking honoraria from UCB, Pfizer, Celgene and Bristol Myers-Squibb.