When rheumatoid arthritis patients, who are in sustained periods of remission, taper their disease-modifying antirheumatic drugs (DMARDs), or biologics, dosage, it’s been unknown which strategy was most likely to succeed.

Japanese researchers, who presented their findings at the 2017 American College of Rheumatology annual meeting in San Diego, found that such patients are most successful if they are young, don’t use steroids, and have low levels of serum C-reactive protein (CRP), which increases when there is inflammation.

“Biologic DMARDs are effective in treating patients with RA, but they are associated with high costs and dose-dependent adverse effects,” said lead author Takaaki Komiya, of Yokohama City University Graduate School of Medicine.

Komiya and colleagues studied 347 rheumatoid arthritis patients at two Japanese university hospitals. The patients had taken either infliximab, adalimumab, etanercept, golimumab, certolizumab-pegol, tocilizumab, or abatacept for six months or less. Of the 347, 255 had stable treatment, while 92 tapered their drug intake.

Although the two groups were similar, researchers found differences. The mean age of patients who successful tapered was 47.1 years, compared to 51 years in the stable group, and nearly three-quarters of those who successfully tapered hadn’t taken DMARDs, compared to just 56 who hadn’t taken DMARDs in the stable group. And patients with lower C-reactive protein levels were likelier to taper successfully.

“The results of this preliminary study may help rheumatologists to differentiate RA patients who would successfully down-titrate biologics,” Komiya said. “This management might result in substantial reduction in costs and possible reduction in dose-dependent side effects.”

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