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17-04-2019 | Rheumatoid arthritis | Highlight | News

RA flare rates unaffected by tapering strategy


medwireNews: Rheumatoid arthritis (RA) flare rates are similar regardless of which drug type is tapered first after achievement of disease control during conventional synthetic (cs)DMARD and tumor necrosis factor (TNF) inhibitor combination therapy, research shows.

Writing in the Annals of the Rheumatic Diseases, Elise van Mulligen (Erasmus Medical Centre, Rotterdam, the Netherlands) and co-authors say that since tapering TNF inhibitors was not superior to that of csDMARDs they would recommend tapering the TNF inhibitor first, in line with current EULAR guidelines.

They add: “From a societal perspective, it would be sensible to taper the TNF inhibitor first, because of possible cost reductions and less long-term side effects.”

van Mulligen and co-investigators found that the proportion of patients who experienced a flare during 1 year of follow-up in the TARA study was 33% among those randomly assigned to taper the csDMARD (n=94), which was typically methotrexate, and 43% among those randomly assigned to taper the TNF inhibitor (n=95), typically etanercept or adalimumab.

All of the 189 patients (mean age 56.6 years, 66.1% women) included in the study had achieved a disease activity score at 44 joints (DAS44) of 2.4 or lower, and a swollen joint count (SJC) of one or lower at two consecutive time points within a 3-month interval before randomization.

The tapering strategy for the csDMARDs consisted of halving, quartering, then stopping the dose completely, while the TNF inhibitor dose interval was first doubled, then the dose was cut in half and then stopped. The schedule took 6 months in total, with dose adjustments at 3-month intervals providing there was still controlled disease.

During the first 9 months, the flare rates were similar between the two groups and increased steadily with time.

However, between 9 and 12 months, the flare rate stabilized in the csDMARD group, but continued to increase in the TNF inhibitor group, therefore “[d]ata of the second year are needed to investigate if [the difference between the two strategies] will increase,” van Mulligen and team remark.

By the end of the study period, 62% of patients in the csDMARD-tapering group and 47% of those in the TNF inhibitor group had completely stopped their medication. Conversely, 9% and 17%, respectively, were back at their original dose.

The team also found that there was no significant difference in mean DAS, quality of life (as measured by the European Quality of Life-5 Dimensions instrument), and functional ability (as measured by the HAQ-DI) at 1 year or over time between the two tapering strategies.

Nor were there any significant differences in adverse event rates or radiographic progression.

By Laura Cowen

medwireNews is an independent medical news service provided by Springer Healthcare. © 2019 Springer Healthcare part of the Springer Nature group

Ann Rheum Dis 2019; doi:10.1136/annrheumdis-2018-214970

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