Novel Relapse Prediction Tool Allows Successful Tapering of DMARDs in Rheumatoid Arthritis

Combining 2 measurements helps accurately predict the risk of relapse in patients with rheumatoid arthritis (RA) and, in turn, could be used to implement tapering of disease-modifying anti-rheumatic drugs (DMARDs). As a result, this technique could help reduce the cost of treatment, a recent study by the European League Against Rheumatism suggests.

In the study, investigators created a risk-stratified tapering model based on different relapse rates, using the multiple-biomarker disease activity (MBDA) score and anti-citrullinated protein (ACPA) status as predictors.

Prior results from the RETRO study demonstrated that more than half of patients stay in remission after tapering or stopping conventional DMARD treatment. Relapses did occur, especially in the first 6 months after treatment reduction, which was associated with the presence of ACPA.

However, the authors of the current study noted that further improvement was needed for prediction models of disease relapse based on ACPA status alone.

“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 lead author Dr Melanie Hagen.

In the current study, patients with RA who had a low MBDA score of <30 and a negative ACPA status had the lowest risk of relapse at 19%. Among patients with moderate to high MBDA scores greater than or equal to 30 or single positivity for ACPA, the relapse risk was found to increase, with the highest risk found in patients with double-positive ACPA (61%).

“On this basis, DMARD tapering appeared feasible in the MBDA-low/ACPA-negative patients, and in MBDA moderate/high/ACPA negative patients,” according to press release.

The investigators used baseline blood samples from 146 patients with RA who had sustained remission and had been enrolled in the RETRO study to determine MBDA scores and ACPA status.

Patients either continued their current DMARD treatment regimen, tapered the dose by 50%, or stopped their DMARDS altogether after 6 months of tapering. They were observed for 1 year, and direct treatment costs were evaluated every 3 months.

The findings were presented at the Annual European Congress of Rheumatology 2017.