The management of patients with inflammatory arthritis (IA) have significantly improved over the last decades due to increased focus on disease activity-guided monitoring and enhanced treatment options including biologic and targeted synthetic disease modifying anti-rheumatic drugs (b-/tsDMARDs, respectively). As the majority of patients with IA now can reach sustained remission or low disease activity (LDA), a relevant question is if the therapies should be continued at standard dose indefinitely.

This thesis is based on three studies evaluating different aspects of biologic dose reduction in patients with IA in sustained remission or LDA compared to continuation of biologic standard dose.

Study I was a systematic literature review and meta-analysis based on RCTs. Tumour necrosis factor inhibitor (TNFi) withdrawal compared to standard dose continuation was proven to have a highly increased risk for flare and persistent flare whereas b-/tsDMARDs tapering versus standard dose continuation only demonstrated a significantly increased risk for flare and not for persistent flare. Moreover, a highly increased risk for flare and persistent flare was observed when comparing withdrawal to tapering in a network meta-analysis.

Study II was an 18-month long pragmatic, randomised, open-label, equivalence trial aiming to investigate if disease activity-guided tapering could reduce the biologic dose significantly while maintaining stable disease activity compared to continuation of biologics as usual care. One-hundred-and-forty-two patients with IA in sustained LDA on stable dose biologics during ≥12 months were enrolled and randomised. At 18-months, disease activity between the two trial groups were equivalent despite significantly more patients in the tapering group received ≤50% of their baseline biologic dose compared to the continuation group.

Study III aimed to explore potential predictors for successful tapering of biologics based on data from Study II. At 18 months, one third of patients in the tapering group had achieved successful tapering (≥50% dose reduction and maintained LDA). A multivariable regression analysis identified better baseline mental health as a potentially important non-significant predictor.

Line Uhrenholt
E-mail: l.uhrenholt@rn.dk
AALBORG UNIVERSITY HOSPITAL
Department of Rheumatology
9000 Aalborg

Photo: Lene Pedersen/Aalborg University Hospital