DISEASE ACTIVITY-GUIDED TAPERING OF BIOLOGICS IN PATIENTS WITH INFLAMMATORY ARTHRITIS: A RANDOMISED, OPEN-LABEL, EQUIVALENCE TRIAL
Authors: L. Uhrenholt et al.
Therapy with biologics is usually a long-term treatment. Tapering or discontinuation of therapy has been shown in studies to be possible. Whereas in RA there is a growing evidence for tapering of biologics, the data in axSpA is still limited. This randomized open-label trial included patients with RA, PsA and axSpA in low disease activity on bDMARD treatment. Patients were randomized to a tapering group, with increase of the dosing interval by 25% every 4 months until flare or discontinuation, and a continuation group, that had no change of therapy. 142 patients were randomized and followed up for 18months. 37% of the patients in the tapering group could reduce their biologic dose by 50% or more. The flare rate was higher in the tapering group (41% vs 21%), but the disease activity at 18 months was equivalent. Flares could be managed by dose increase of biologic or glucocorticoids. 1 patient (1%) in the tapering group and 3 patients (6%) in the continuation group lost therapeutic response and had to be switched to another bDMARD.
With disease activity guided tapering of biologics, a significant dose reduction is possible, while at the same time maintaining suppression of disease activity. These results were obtained in a mixed patient population. Unfortunately, the patient numbers are too small to analyse differences between RA, PsA and axSpA patients in this study.