medwireNews: Patients with rheumatoid arthritis (RA) who stop biologic DMARD therapy have an increased risk for relapse and radiographic progression compared with those who continue treatment, researchers report.
These findings are based on the results of a systematic review and meta-analysis of nine published studies including 766 RA patients who discontinued treatment with biologics – including adalimumab, etanercept, abatacept, and certolizumab pegol – after achieving low disease activity (LDA) or remission, and 1054 patients who continued biologic therapy.
“The latest European and American recommendations propose a decrease or even discontinuation of [biologics] for patients with RA in persistent remission, after having tapered glucocorticoids, in order to decrease the risk of serious infections and to reduce the costs of [biologic] DMARDs,” explain Adeline Ruyssen-Witrand (Hôpital Purpan, Toulouse, France) and fellow researchers.
As reported in the Annals of the Rheumatic Diseases, patients who discontinued biologics had approximately double the risk for losing remission or LDA over 1 year of follow-up compared with those who continued treatment, with risk ratios (RR) of 1.97 and 2.24, respectively.
Stopping biologic therapy was also associated with a smaller, but still significant, increased risk for radiographic progression, at an RR of 1.09.
The researchers also found that tapering the dose of biologics was associated with some risks for patients. In seven published articles and four conference abstracts in which 835 patients reduced their biologic dose and 755 continued with the same dose, tapering treatment was associated with a significantly increased risk for losing remission over 6–18 months of follow-up (RR=1.23).
However, patients who tapered their treatment did not have a significantly higher risk for losing LDA or experiencing radiographic progression than those who continued with the same treatment regimen.
The researchers note that most of the included studies “were of good methodological quality,” and most had low or unclear bias.
Taken together, these findings indicate that biologic discontinuation “exposes the patient to an increased risk of relapse and radiographic progression,” they say.
However, because tapering did not have a significant effect on LDA and radiographic progression, the team believes that “a dose reduction strategy (lowering or spacing doses) appears to be a reasonable option for patients with RA in stable remission or LDA.”
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