DMARD Tapering Success in RA Predicted With MBDA Score, ACPA Status

Researcher preparing blood samples
Researcher preparing blood samples
Researchers analyzed the effect of a risk-stratified DMARD-tapering algorithm based on MBDA score and ACPA on direct treatment costs for patients with RA in sustained remission.

In patients with rheumatoid arthritis (RA) in deep remission, the combination of multibiomarker disease activity (MBDA) score and anticitrullinated protein antibodies (ACPA) status can stratify the risk for successful, cost-effective tapering of disease-modifying antirheumatic drugs (DMARDs), according to results published in The Journal of Rheumatology.

The study included participants with RA in sustained remission tapering and stopping DMARD treatment (n=146). Participants were stratified into 3 groups: those continuing DMARDs, those tapering their dose by 50%, and those stopping after tapering. The researchers determined MBDA scores and ACPA status at baseline. They followed participants over 1 year with direct treatment costs evaluated every 3 months.

The results indicated that participants with a low MBDA score (<30 units) and negative ACPA status had the lowest risk for relapse (19%), whereas those with positive scores on both measures had the highest risk for relapse (61%).

Tapering was feasible in participants who were are ACPA-negative and MBDA-negative (<30 units) and for those who were positive for ACPA or MBDA (but not both).

For participants without flare, the researchers found that the direct costs of synthetic and biologic DMARD in the ACPA-/MBDA-negative and single positive groups (n=41) would be €372,245.16 for full-dose treatment over 1 year. However, tapering and stopping DMARDs among these participants led to a reduction of €219,712.03 in DMARD costs. The average reduction of DMARD costs per participant was €5358.83.

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“Our present study shows that tapering or stopping DMARD achieves savings of direct healthcare costs, if the likelihood for relapse is low and the patients can permanently stay on a tapered DMARD regimen or could even stop treatment,” the researchers wrote.

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Hagen M, Englbrecht M, Haschka J, et al. Cost-effective tapering algorithm in rheumatoid arthritis patients: combination of multibiomarker disease activity score and autoantibody status [published online December 1, 2018]. J Rheumatol. doi:10.3899/jrheum.180028