SAN DIEGO — For physicians wondering which of their patients with rheumatoid arthritis can successfully taper their biologic therapy, researchers from Japan have some insights.
Patients who are younger, on their first biologic, not taking concomitant corticosteroids, or who have low serum C-reactive protein levels are significantly more likely to effectively roll back their biologic, said Takaaki Komiya, MD, from Yokohama City University Graduate School of Medicine in Japan.
“Biologics are effective in rheumatoid arthritis, and many patients are able to achieve remission,” he explained here at the American College of Rheumatology 2017 Annual Meeting. But the drugs are expensive and associated with adverse effects, including infections.
“Some reports have shown that patients can successfully maintain remission after stopping biologics. However, the patient selection for this has not been established yet,” Dr Komiya explained.
To examine the issue, Dr Komiya and his colleagues assessed 255 patients on stable treatment and 92 who tapered their abatacept adalimumab, certolizumab-pegol, etanercept, golimumab, infliximab, or tocilizumab.
The study participants were treated at one of two university hospitals, reflecting more of a real-world population than randomized controlled trials reported in the literature.
All patients were treated with a biologic for at least 6 months in this retrospective, cross-sectional analysis. Mean age was 63 years, mean disease duration was 12 years, and 84% of the study participants were women.
Five patients experienced a disease flare related to titration after a mean of 8 months.
Table. Factors Associated With Successful Tapering of a Biologic on Univariate Analysis
| Factor | Stable Dose | Tapered | P Value |
|---|---|---|---|
| No previous biologic therapy | 57% | 77% | .001 |
| Age at disease onset | 51 years | 47 years | .03 |
| Age at biologic initiation | 60 years | 56 years | .02 |
| Steroid use | 43% | 35% | .04 |
| C-reactive protein serum level | 1.9 mg/L | 1.1 mg/L | .03 |
There was no significant difference in tapering success between the two groups when the patients were stratified by disease duration, route of administration, prevalence of the anticitrullinated protein antibody and rheumatoid factor, tender joint count, swollen joint count, patient global assessment, disease activity score in 28 joints with erythrocyte sedimentation rate (ESR), or x-ray findings at baseline.
However, on multivariate analysis, there was a significant association between a low level of serum C-reactive protein at baseline and successful titration (odds ratio, 0.81; P = .03).
“It’s been really hard for us to predict which of these patients can actually back down on biologics or stop them altogether,” said news conference moderator Paul Sufka, MD, from HealthPartners in Minneapolis.
“If you think about what factors people are thinking about with biologics right now, they’re expensive, people are worried about side effects — mostly infections — and people just want to be on less medication if they can,” he told Medscape Medical News.
It would have been useful to know how the researchers defined tapering success, Dr Sufka added.
Dr Komiya and Dr Sufka have disclosed no relevant financial relationships.
American College of Rheumatology (ACR) 2017 Annual Meeting: Abstract 1460. Presented November 6, 2017.
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