medwireNews: Tapering of biologic DMARDs or Janus kinase (JAK) inhibitors does not significantly reduce serious infection or serious adverse event (SAE) rates in people with rheumatoid arthritis (RA) or axial spondyloarthritis (axSpA), meta-analysis data show.
“Nevertheless, other benefits of a tapering strategy, including alleviating patient burden due to self-injection, medication costs, and the safety of these strategies in relation to flare-ups leads us to support this therapeutic approach,” write Dorothee Vinson (CHU Sainte Marguerite, Marseille, France) and co-authors in Arthritis Research & Therapy
The study included data for 2196 patients in remission or a low disease activity state from 13 studies (nine RA and four axSpA) published up to August 2019 that compared tapering of targeted therapy with continuation of the same treatment.
Among the patients with RA, the mean DAS28-CRP ranged from 1.6 to 2.3 and the most commonly studied therapies were the tumor necrosis factor (TNF) inhibitors etanercept, adalimumab, and certolizumab. Abatacept and baricitinib were each investigated in one RA study.
TNF inhibitors (etanercept, adalimumab, infliximab, and golimumab) were also the most commonly studied therapy among the patients with axSpA. In this group the mean BASDAI SpA ranged from 1 to 2.
Vinson et al report that during 1174 patient–years of follow-up, 20 patients in the tapering group experienced serious infection, corresponding to a rate of 1.7 per 100 patient–years.
This was not significantly different from the rate of 2.6 per 100 patient–years among the individuals who continued with usual care and experienced 28 serious infections in 1087 patient–years.
There was also no significant difference between the tapering and continuing groups in the rates of SAEs (7.4 vs 6.7 per 100 patient–years), malignancies (1.8 vs 0.8 per 100 patient–years), cardiovascular adverse events (1.3 vs 2.1 per 100 patient–years), or deaths (0.2 vs 0.1 per 100 patient–years).
Furthermore, subgroup analysis by disease type showed no significant differences in any of the outcomes between the patients with RA and those with axSpA.
Vinson and team therefore conclude that their “meta-analysis highlights no remarkable difference in the rate of infectious events, in patients in the tapering treatment group or patients continuing their initial treatment schedule.”
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