New Relapse Prediction Tool Could Cut RA Costs

A study presented at the 2017 EULAR Congress showed that using two measurements can accurately predict relapse risk among RA, allowing physicians to adjust dosing of disease-modifying antirheumatic drugs (DMARDs). This new prediction tool thus improves the cost-effectiveness of expensive DMARDs.  

Limited research has investigated whether antirheumatic treatment can be reduced or stopped outright, and how to predict which patients are least likely to relapse after less treatment. A previous study (RETRO) showed that more than half of patients remain in remission after reducing or stopping DMARD treatment. Relapses often occurred within the first 6 months and were associated with the presence of anticitrullinated protein (ACPA).

Melanie Hagen, MD, University of Erlangen-Nuremberg (Germany), and colleagues conducted a study to further assess the effects of a controlled DMARD tapering regimen on
treatment costs. Researchers sampled 146 patients from the RETRO trial who either continued their current DMARD regimen, tapered the dose by 50%, or stopped their DMARD regimen altogether after 6 months of tapering. Patients were observed for 12 months and direct treatment costs were evaluated every 3 months.

Researchers found that patients with a low multiple-biomarker disease activity (MBDA) score (< 30) and negative ACPA status showed the lowest risk of relapse (19%). A moderately high MBDA score (> 30) or single positivity for APCA resulted in a higher risk of relapse, with the highest risk in those patients with double-positive ACPA (61%).

Examining related costs, researchers determined that synthetic and biologic DMARDs in the MBDA-low and single-positive group
(n = 41) would have cost €123,751.29 for full-dose treatment over 1 year. Tapering and stopping DMARDS in the low-risk relapse groups allowed for a 75% reduction in DMARD costs (approximately €92,821.50).

Average cost reduction per patient was €2350.08 in the MBDA-low/ACPA-negative and the MBDA-low/ACPA-single positive groups, and €1761.43 in the MBDA-moderately high/ACPA single-positive group.—Zachary Bessette