Tapering biologics, csDMARDs leads to increased flares in patients with RA
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Patients with rheumatoid arthritis who underwent a biologic and/or disease-modifying antirheumatic drug taper were more likely to experience flares and have a shorter time to flare, said a speaker at ACR Convergence 2021.
The long-term use of biologics and conventional synthetic DMARDs (csDMARDs) in the treatment of RA has been associated with clinical risks, such as infection and malignancy. Medication tapering remains a potential option for patients with chronic RA who have achieved remission.
“This is a real-world study that we did to look at the clinical outcomes of tapering biologics or DMARDs in RA patients who are in sustained remission,” Mohamed Tageldin, MBBCH, second-year rheumatology fellow at Allegheny Health Network, said during his poster presentation.
“The primary outcome that we were looking at was the proportion of flares at the end of the period, and we also looked at the type of flare as a secondary outcome.”
Tageldin and colleagues included 131 patients with RA who had confirmed sustained remission on biologics and/or csDMARDs in a 2-year prospective cohort study. Sustained remission was defined as a Clinical Disease Activity Index (CDAI) score of 2.8 or less, stable RA medication use, and absence of flares for a period of at least 6 months. The study was conducted from November 2018 to November 2020 with at least 6 months of follow up. Provider consensus was used to predetermine biologic tapering regimens.
Of the 131 patients, 51 underwent a medication taper, of which 22 tapered biologics, 23 tapered csDMARDs and six tapered both biologics and csDMARDs.
Researchers found that the biologic and csDMARD group was most likely to experience a flare (OR = 27; 95% CI, 3-213) and have a shorter time to flare (HR = 8.9) as compared with the no-taper group. The increased likelihood of flares was also observed in the biologic-only tapered group (OR = 11; 95% CI, 3.2-41) and the csDMARD-only tapered group (OR = 2.74; 95% CI, 0.57-13), as was the shorter time to flare (HR = 8.10 and HR = 1.42 respectively).
Those undergoing any medication taper were also significantly more likely to experience a flare in the follow-up period (OR = 7.68; 95% CI, 2.4-24) compared with those not undergoing medication taper. Flare was reported by 15% of patients (n = 20) within the follow-up period, of which five were in the no-taper group and 15 were in the taper groups. In the tapered groups, 100% of patients who experienced a flare regained remission within an average of 2.5 months.
However, due to the wide confidence intervals, larger studies in the future are needed to study tapering these medications, Tageldin noted during the presentation.
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Tageldin M, et al. Abstract #0809. Presented at: ACR Convergence 2021; November 3-10, 2021 (virtual meeting).
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