OP0113 Gradual tapering tnf blockers versus conventional synthetic dmards in patients with rheumatoid arthritis in sustained remission: first year results of the randomised controlled tara-study. (12th June 2018)

• Record Type: Journal Article
• Authors: Van Mulligen, E.; Weel, A. E. A. M.; Kuijper, T.M.; Luime, J.J.; Hazes, J.M.W.; de Jong, P.?H.P.
• Is Part Of: Annals of the rheumatic diseases. Volume 77(2018)Supplement 2
• Page Start: 107
• Page End: 107
• Publication Date: 2018-06-12
• Subjects: Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/annrheumdis-2018-eular.1908
• Languages: English
• ISSNs: 0003-4967

Abstract

Abstract : Background: Clinical and radiographic outcomes in rheumatoid arthritis (RA) have improved enormously in the last two decades, due to early detection of the disease, early initiation of 'intensive' therapy and a treat-to-target approach. As a result, 50%–60% of early RA patients will achieve sustained remission during the first year of follow-up. In aforementioned cases current guidelines recommend to consider tapering treatment, but an optimal approach to gradually de-escalate conventional synthetic or biologic DMARDs (respectively csDMARDs and bDMARDs) is currently lacking. Objectives: The aim of this study is to evaluate the effectiveness of two tapering strategies, namely gradual tapering of csDMARDs and anti-TNF therapy during one year of follow-up. Methods: In this multicenter single-blinded randomised controlled trial RA patients in sustained remission for at least 3 consecutive months, defined as a DAS≤2.4 and a swollen joint count (SJC)≤1, which was achieved with csDMARDs and a TNF blocker were included. Eligible patients were randomised into gradual tapering csDMARDs followed by the TNF blocker or vice versa. Medication was tapered in three steps over the course of 6 months. Gradual tapering was done by cutting the dosage into half, a quarter and thereafter it was stopped. The primary outcome for the clinical effectiveness was disease flare defined as DAS44 >2.4 and/or SJC>1. Secondary outcomes were quality of life and functional ability. Results: A total of 187 patients were randomly assigned to tapering csDMARDs (n=93) or tapering anti-TNF (n=94). Patients had an average symptom duration of 6.7 years and were predominantly female (66%) with an average age of 56.4 years (figure 1A). The cumulative flare ratio in the csDMARD and anti-TNF tapering group was respectively 32% and 41% (figure 1B), which corresponds with a hazard ratio of 0.91 (95% CI: 0.68 to 1.22, p=0.55). In the last 3 months the increase in cumulative flare ratio differs the most between the two groups. On the other hand, in 48% and 51% of patients respectively tapering csDMARDs or anti-TNF the medication could be completely withdrawn (figure 1C). Percentages of patients which are not completely tapered are higher than the flare ratios, due to loss of remission without a disease flare. Furthermore, mean DAS and mean HAQ over time, and after 1 year, did not differ between both tapering groups (figure 1D and E). Conclusions: There were no significant differences in flare ratios, disease activity and functional ability between both tapering strategies during the first year of follow-up. Therefore, in RA patients who are in sustained remission we advise to taper anti TNF first, but before tapering therapy rheumatologists should take the risk of a disease flare and patient's wishes into account. Disclosure of Interest: None declared