Depressive symptoms linked to flare risk after tapering TNF inhibitors in RA patients
medwireNews: Results of a post-hoc analysis suggest that symptoms of depression are associated with increased flare risk after tapering tumor necrosis factor (TNF) inhibitors among patients with rheumatoid arthritis (RA).
“Disease activity-guided dose tapering or discontinuation of [TNF inhibitor] therapy appears to be feasible, safe and effective in a selected proportion of patients with rheumatoid arthritis,” but between one- and two-thirds of patients reportedly flare after stopping or tapering treatment, say Katie Bechman (King’s College London, UK) and study co-authors.
“[B]eyond the demonstration of clinical remission by 28-joint count Disease Activity Score (DAS28), there are no standardized methods to identify patients in whom treatment tapering is likely to be successful,” they add.
The researchers analyzed data from the OPTTIRA trial, in which 97 RA patients with sustained low disease activity were randomly assigned to taper their TNF inhibitor dose by 33% or 66% or to continue with their original dose for 6 months. Patients in the dose reduction groups who did not flare during this period tapered further and completely stopped their TNF inhibitor treatment by month 12, while those in the control group were randomly assigned to one of the dose reduction strategies at month 6.
In all, 42% of patients experienced a flare – defined as an increase in DAS28 score of at least 0.6 points, resulting in a score of 3.2 points or more – over the 1-year study period.
Patients with worse mental health at baseline, indicated by a lower SF-36 mental health (MH) subscale score, had a significantly elevated risk for flare over 1 year of follow-up after adjustment for age, sex, trial arm, body mass index, and disease activity, with flare risk increasing by 25% with every 10-point decrease in SF-36 MH score.
The researchers also found that baseline DAS28 score was significantly associated with flare risk (adjusted hazard ratio=1.96). Overall SF-36 mental component summary scores, as well as SF-36 physical component scores, significantly predicted flare risk in unadjusted analyses, but the associations were no longer significant after adjusting for potentially confounding factors.
“Unlike the other variables, the SF-36 MH subscale specifically assesses depressive symptoms with items relating to low mood, nerves and restlessness,” explain Bechman and team.
Therefore, the study results suggest that “depression alone can independently predict flare in patients who taper their anti-TNF agents,” they add.
And the team concludes in RMD Open: “Based on these findings, an assessment of mental health and functional status should be considered prior to dose reduction.”
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