Disease activity-guided tapering of biologics in patients with inflammatory arthritis: a pragmatic, randomized, open-label, equivalence trial

L. Uhrenholt*, R. Christensen, L. Dreyer, E. M. Hauge, A. Schlemmer, A. G. Loft, M. N.B. Rasch, H. C. Horn, K. H. Gade, R. D. Østgård, P. C. Taylor, K. Duch, S. Kristensen

*Corresponding author af dette arbejde

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avisTidsskriftartikelForskningpeer review

Abstract

Objective: To evaluate whether disease activity-guided tapering of biologics compared to continuation as usual care enables a substantial dose reduction while disease activity remains equivalent. Method: In this pragmatic, randomized, open-label, equivalence trial, adults with rheumatoid arthritis, psoriatic arthritis, or axial spondyloarthritis in low disease activity on stable-dose biologics for ≥ 12 months were randomized 2:1 into either the tapering group, i.e. disease activity-guided prolongation of the biologic dosing interval until flare or withdrawal, or the control group, i.e. maintaince of baseline biologics with a possible small interval increase at the patients request. The co-primary outcome in the intention-to-treat population was met if superiority in ≥ 50% biologic reduction at 18 months was demonstrated and disease activity was equivalent (equivalence margins ± 0.5).      Results: Ninety-five patients were randomized to tapering and 47 to control, of whom 37% (35/95) versus 2% (1/47) achieved ≥ 50% biologic reduction at 18 months. The risk difference was statistically significant [35%, 95% confidence interval (CI) 24%–45%], while disease activity remained equivalent [mean difference 0.05, 95% CI −0.12–0.29]. A statistically significant flare risk was observed [tapering 41% (39/95) vs control 21% (10/47), risk difference 20%, 95% CI 4%–35%]; but, only 1% (1/95) and 6% (3/47) had persistent flare and needed to switch to another biological drug.   Conclusions: Disease activity-guided tapering of biologics in patients with inflammatory arthritis enabled one-third to achieve ≥ 50% biologic reduction, while disease activity between groups remained equivalent. Flares were more frequent in the tapering group but were managed with rescue therapy. .

OriginalsprogEngelsk
TidsskriftScandinavian Journal of Rheumatology
Vol/bind52
Nummer5
Sider (fra-til)481-492
Antal sider12
ISSN0300-9742
DOI
StatusUdgivet - sep. 2023

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