Researchers developed a method of identifying candidates with rheumatoid arthritis (RA) for dose reduction of disease modifying anti-rheumatic drugs (DMARDs).
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The development and widespread use of DMARDs has resulted in approximately 50% or patients with RA achieving disease remission. Limited research has investigated whether anti-rheumatic 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 six months and were associated with the presence of anti-citrullinated 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 three months.
Results of the study were presented at the Annual European Congress of Rheumatology (June 16, 2017; Madrid, Spain).
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 one 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 €2,350.08 in the MBDA-low/ACPA-negative and the MBDA-low/ACPA-single positive groups, and €1,761.43 in the MBDA-moderately high/ACPA single-positive group.
"Having shown in the RETRO study that those RA patients who relapse after tapering their DMARDs respond well to their reintroduction, a structured tapering and stopping of DMARDs is not only a cost economic strategy, but also clinically feasible," said Dr Hagen.—Zachary Bessette
