Successful Biologics Tapering in Rheumatoid Arthritis Predicted by Younger Age, CRP Level

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Patients for whom tapering was successful were younger, bDMARD naive, had no concomitant use of corticosteroids, and had low serum CRP levels.
Patients for whom tapering was successful were younger, bDMARD naive, had no concomitant use of corticosteroids, and had low serum CRP levels.
The following article features coverage from ACR 2017 in San Diego, California. Click here to read more of Rheumatology Advisor's conference coverage.

SAN DIEGO — Patients with rheumatoid arthritis (RA) who are in remission may achieve more successful tapering of biologic medication if they are younger, naive to biological disease-modifying antirheumatic drugs (bDMARDs), have no concomitant use of corticosteroids, and have low levels of C-reactive protein (CRP), according to data presented at the 2017 ACR/ARHP Annual Meeting.

Takaaki Komiya, MD, of the Department of Stem Cell and Immune Regulation at Yokohama City University Graduate School of Medicine in Japan, presented the findings at the meeting. Dr Komiya noted that bDMARDs can be tapered in patients with RA if they are in sustained remission, but many patients experience relapse. There is currently little evidence about down-titration of bDMARDs in the real world.

The study included 347 patients with RA who fulfilled the 1986 ACR or 2010 ACR/EULAR classification criteria and were treated with 1 of 6 biologics for longer than 6 months. Biologics included in the study included infliximab, adalimumab, etanercept, golimumab, certolizumab pegol, tocilizumab, and abatacept. The researchers identified 255 patients to receive stable and standard-dose treatment, while 92 patients underwent dose tapering.

The researchers found that 5 patients (1.4%) experienced a disease flare after down-titration of bDMARD after 8.4 ± 5.7 months. There was no significant difference between groups with regard to disease duration, prevalence of anticitrullinated protein antibody and rheumatoid factor, and radiographicy findings.

The investigators observed that patients for whom tapering was successful were younger at disease onset, with a mean age of 47.1 years compared with 51 years among patients in the stable treatment group. Patients who underwent successful tapering were also younger when they began using biologics (mean age 55.5 vs 59.6 years in the stable treatment group).

In addition, 76.4% of patients who underwent successful tapering were naive to bDMARDs compared with 57.1% of patients in the stable treatment group. Patients were also more likely to experience successful tapering if they had low serum CRP levels and no concomitant use of oral corticosteroids.

“The results of this preliminary study may help rheumatologists to differentiate RA patients who would successfully down-titrate biologics,” Dr Komiya concluded. “This management might result in substantial reduction in costs and possible reduction in dose-dependent side effects.”

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Reference

Komiya T, Takase KM, Sakurai N, et al. Predictive factors associated with successful down-titration of biologics for rheumatoid arthritis patients in clinical practice. Presented at: 2017 ACR/ARHP Annual Meeting; November 3-8, 2017; San Diego, CA. Abstract 827.

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