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Age, Low CRP Levels Increase Odds of Successful Tapering of Biologics in RA
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SAN DIEGO — Younger age, no concomitant steroid use and low C-reactive protein increased the rate of successful tapering of biologic drugs in patients with rheumatoid arthritis in remission, according to data presented at the American College of Rheumatology Annual Meeting.
“Biologic [disease-modifying antirheumatic drugs] DMARDs are effective in treating patients with RA, but they are associated with high costs and dose-dependent adverse effects,” Takaaki Komiya, MD, a researcher at Yokohama City University Graduate School of Medicine in Japan, said in a press release. “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.”
Komiya and colleagues studied 347 patients with RA (mean age, 62.5 years; mean disease duration, 12.3 years; 83.6% were women) who met the American College of Rheumatology classification criteria and were treated with a biologic (infliximab, adalimumab, etanercept, golimumab, certolizumab-pegol, tocilizumab or abatacept) for longer than 6 months.
The study cohort was divided into two groups, 255 patients remained on a stable dose and 92 patients were tapered. The groups had similar baseline disease activity.
Those who successfully tapered were more likely to be younger at younger at disease onset (mean age, 47.1 years vs. 51 years) and start of biologics (mean age, 55.5 years vs. 59.6 years) compared with those who remained on a stable dose. Of those who successfully tapered, 74% were DMARD naïve compared with 56% in the stable treatment group.
Those on a stable dose of biologics were more likely to have concomitant oral corticosteroid use (43% vs 34%) compared with those who were tapered. Low levels of serum CRP at baseline were associated with successful tapering (OR = 0.81).
“An important strength is that this study reflects the ‘real world’ experience,” Komiya said in the release. “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.”
Reference:
Komiya T, et al. Abstract 1460. Presented at: American College of Rheumatology Annual Meeting; Nov. 3-8, 2017; San Diego.
Disclosures: The authors report no relevant financial disclosures.