Paradigm guiding to tapering or discontinuation of biologic and targeted synthetic disease-modifying antirheumatic drugs in the treatment of patients with rheumatoid arthritis: Results from a local prospective study
International Journal of Rheumatic Diseases, cilt.26, sa.4, ss.689-698, 2023 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 26 Sayı: 4
- Basım Tarihi: 2023
- Doi Numarası: 10.1111/1756-185x.14616
- Dergi Adı: International Journal of Rheumatic Diseases
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Academic Search Premier, EMBASE, MEDLINE
- Sayfa Sayıları: ss.689-698
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Objective: We prospectively conduct the current study to figure out predicting factors whether biologic and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) can be discontinued or tapered in patients with rheumatoid arthritis (RA). Materials and Methods: The study population encompassed 126 consecutive RA patients on b/tsDMARDs for at least 1 year. Remission was defined as a Disease Activity Score of 28 joints (DAS28) - erythrocyte sedimentation rate <2.6. The b/tsDMARD dosing interval was increased in patients in remission for at least 6 months. In patients in whom the b/tsDMARD dosing interval could be increased by 100% for at least 6 months, the b/tsDMARD was stopped at the end of this period. Disease relapse was defined as deterioration from remission to moderate or high disease activity. Results: The mean duration of b/tsDMARD treatment for all patients was 2.54 ± 1.55 years. Logistic regression analysis did not identify any independent predictor of treatment discontinuation. Independent predictors for tapering in b/tsDMARD treatment are no switch to another therapy and lower baseline DAS28 scores (respectively, P =.029,.024). Time to relapse after tapering was shorter in patients requiring corticosteroids when the 2 groups were compared with the log-rank test (2.83 vs 10.8 months; P =.05). Conclusion: It seems a reasonable approach to consider b/tsDMARD tapering in patients with remission period of >3.5 months, lower baseline DAS28 scores and without requiring corticosteroid use. Unfortunately, no predictor has been found to predict b/tsDMARD discontinuation.