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BIOLOGIC TAPERING SUCCESSFUL AND COST-EFFECTIVE IN RA PATIENTS WITH LOW DISEASE ACTIVITY
Newswise — CHICAGO – Rheumatoid arthritis patients who achieve low disease activity or remission may successfully taper their biologics, saving costs as a result, according to new research findings presented this week at the 2018 ACR/ARHP Annual Meeting (Abstract #625).
Rheumatoid arthritis (RA) is the most common type of autoimmune arthritis. RA is caused when the immune system, the body’s defense system, does not work properly. RA causes pain, swelling, and progressive damage in the wrist and small joints of the hands and feet, and may also affect organs such as the eyes, skin or lungs. It affects more than 1.3 million Americans, of which about 75 percent are women.
According to several studies, RA patients who achieve low disease activity or remission targets can successfully taper their biologic disease-modifying antirheumatic drugs (bDMARDs). A group of researchers in Belgium conducted a retrospective study to evaluate the proportion of patients for whom bDMARDs can be tapered in daily clinical practice. They also analyzed the characteristics of “tapering” patients, determined which biologics more easily adapt to dose tapering and looked at cost savings.
“Tapering of biologics is essential in daily care,” said Patrick Durez, MD, Head of Clinic, Division of Rheumatology, Université Catholique de Louvain (UCLouvain) in Brussels, and the study’s co-author. “The unmet needs for this research are numerous, including the physician’s decision not to follow guidelines addressed by the industry.”
The study included patients from an UCLouvain cohort who were treated with a bDMARD for at least one year. Dose reduction was proposed by a senior physician when a patient achieved low disease activity or remission. The researchers also collected data on patient characteristics and baseline features before the introduction of the current bDMARD, and when flares occurred. They also calculated the proportion of patients who received a decreased dose and the annual cost for each bDMARD.
The study included data from 332 eligible RA patients, including 140 patients who received a tapered bDMARD regimen and 192 who received the full dose. In the tapered dose group, the age at diagnosis was 43.1 compared to 38.7 in the full dose group. Health Assessment Questionnaire (HAQ) scores were lower in the tapering group compared to the full dose group. Other statistically different factors in the two groups were rheumatoid factor (83.3 versus 72.9), disease duration at the introduction of bDMARDs (9.7 versus 12.1 years) and the concomitant use of methotrexate (86.7 percent vs 73.8 percent).
No differences between the groups were observed for gender, anti-citrullinated protein antibody (ACPA), erosions, the number of previous bDMARDs, the time to first conventional synthetic DMARD and bDMARD, baseline DAS28-CRP and glucocorticoid use. As expected, current DAS28-CRP (Disease Activity 28 and C-Reactive Protein) scores were lower in the tapered dose group. Only 15 patients had a flare during the follow-up.
Anti-tumor necrosis factor (TNF) agents were the most commonly prescribed bDMARDs in this cohort. Adalimumab, etanercept and rituximab were the most frequently tapered bDMARD in the study, and these were also associated with the most important reductions in annual cost. The study’s findings show that in daily clinical practice, a large proportion of RA patients with low disease activity or remission may successfully taper bDMARDs and reduce annual cost.
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About the ACR/ARHP Annual Meeting
The ACR/ARHP Annual Meeting is the premier meeting in rheumatology. With more than 450 sessions and thousands of abstracts, if offers a superior combination of basic science, clinical science, tech-med courses, career enhancement education and interactive discussions on improving patient care. For more information about the meeting, visit https://www.rheumatology.org/Annual-Meeting, or join the conversation on Twitter by following the official #ACR18 hashtag.
About the American College of Rheumatology
The American College of Rheumatology is an international medical society representing over 9,400 rheumatologists and rheumatology health professionals with a mission to empower rheumatology professionals to excel in their specialty. In doing so, the ACR offers education, research, advocacy and practice management support to help its members continue their innovative work and provide quality patient care. Rheumatologists are experts in the diagnosis, management and treatment of more than 100 different types of arthritis and rheumatic diseases. For more information, visit www.rheumatology.org.
Abstract #: 625
Tapering of Biological Antirheumatic Drugs in Rheumatoid Arthritis Patients Is Achievable and Cost Effective in Daily Clinical Practice: DATA from the Brussels UCL RA Cohort
Stéphanie Dierckx1, Bernard R. Lauwerys2, Tatiana Sokolova1, Laurent Meric de Bellefon1, Maria Stoenoiu1, Adrien Nzeusseu Toukap1, Frédéric A. Houssiau2, Aleksandra Avramovska1 and Patrick Durez1, 1Rheumatology - Cliniques universitaires Saint-Luc - Université Catholique de Louvain - Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium, 2Pôle de pathologies rhumatismales systémiques et inflammatoires, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
Background/Purpose: Several studies have demonstrated that Rheumatoid Arthritis (RA) patients achieving low disease activity or remission are able to taper biological disease-modifying antirheumatic drugs (bDMARDs). The aim of this study is to evaluate the proportion of patients in whom the bDMARD can be tapered in daily practice and to analyse the characteristics of these patients e. Another objective is to determine which bDMARDs are more adapted to dose reduction and the cost saving.
Methods: Inclusion criteria were RA patients from our Brussels UCL cohort treated with a bDMARD for at least one year. A dose reduction was proposed by the senior physician when sustained low disease activity or remission was achieved. Patient characteristics and baseline features before the introduction of the current bDMARD were collected as well as flares if happened. We also calculated, for each bDMARD, the proportion of patients who received a decreased dose and the annual cost.
Results: Data from 332 eligible RA patients were collected, 140 patients (42,1%) had a tapered regimen and 192 received a full dose of bDMARD. In the decreased dose group, age at diagnosis (43.1 vs 38.7 years, p=0.004), HAQ (1.3 vs 1.5, p=0.048), RF (83.3 vs 72.9%, p=0.026) and disease duration at the bDMARDs introduction (9.7 vs 12.1 years, p=0.034) were statistically different. As expected, the current DAS28-CRP was lower (2.26 vs 2.64, p=0.001) in the decreased dose group and interestingly, more patients receiving a decreased dose were treated with a combination of methotrexate when the bDMARD was introduced (86.7% vs 73.8%, p=0.005). No difference between groups was observed for gender, ACPA, erosion, number of previous bDMARDs, time to first conventional synthetic DMARD and biological DMARD, baseline DAS28-CRP and use of glucocorticoids. In our cohort, anti-TNF agents were the most commonly prescribed medications (anti-TNF 68%, tocilizumab 15%, rituximab 10%, abatacept 7%). Only 15 patients experienced a flare during the follow-up. Adalimumab, etanercept and rituximab were the most frequent decreased bDMARD and were associated with the most important reduction of annual cost. Figure: Proportion of patients with decreased dose for each bDMARD
Conclusion: In daily practice, tapering of bDMARDs in RA patients with low disease activity or remission is an achievable goal in a large proportion of patients, thereby reducing annual drug cost. The combination with methotrexate could be a positive predictive factor for the success of bDMARD tapering but further prospective research in daily practice are needed to confirm this result.
Disclosures: S. Dierckx, None B. R. Lauwerys, None T. Sokolova, None L. Meric de Bellefon, None M. Stoenoiu, None A. Nzeusseu Toukap, None F. A. Houssiau, None A. Avramovska, None P. Durez, None
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