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Dose tapering of biologic agents in patients with rheumatoid arthritis—results from a cohort study in Germany

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Abstract

Objective

To assess the association of demographic and clinical factors with the clinical decision of tapering biologic disease modifying antirheumatic drugs (bDMARDs) in patients with rheumatoid arthritis (RA) in daily practice.

Methods

All RA patients receiving bDMARDs were documented by 14 rheumatologists when presenting in 9 specialized private practices. Statistical analyses employed multivariable logistic models for dose reduction with the covariates age, gender, disease duration until bDMARD start, smoking status, disease activity, comorbidity, functional capacity, radiographic damage, concomitant methotrexate (MTX) treatment, rheumatoid factor positivity, and glucocorticoid use. In the multivariable model (MVM), missing values were imputed.

Results

Data of 586 RA patients on bDMARD treatment were available, 171 of which (29%) received a reduced dose. The highest rates of patients with dose reduction were seen for rituximab (67%) and infliximab (50%). The degree of dose reduction was most prominent for rituximab (57%). In the MVM, 6/11 covariates were significantly associated with dose reduction: age (odds ratio (OR) 1.03, 95% confidence interval (CI) 1.01–1.05; P = 0.002), time between disease onset and bDMARD start (OR 1.03, 95% CI 1.01–1.06; P = 0.015), DAS 28 < 2.6 (OR 1.55, 95% CI 1.01–2.37; P = 0.045), MTX therapy (OR 1.52, 95% CI 1.03–2.25; P = 0.036), comorbidity (OR 1.20, 95% CI 1.01–1.42; P = 0.036), and glucocorticoid dose (OR 0.82, 95% CI 0.76–0.89; P < 0.001).

Conclusion

DAS 28 remission, concomitant MTX, and lower glucocorticoid doses were positively associated with dose tapering of bDMARDs in RA patients. While this could be expected, the reason for the association with age, comorbidity, and the time between disease onset and bDMARD start is less clear.

Key points

• In rheumatology practice, tapering of biologic disease modifying antirheumatic drugs is feasible in nearly 30% of patients with rheumatoid arthritis.

• The degree of dose reduction may exceed 50% of the recommended dose.

• In a multivariable model, concomitant methotrexate is positively associated with dose tapering of biologic disease modifying antirheumatic drugs.

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Additional data will be available on request.

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Acknowledgments

The authors thank the participating patients and the members of the WILDWEST-group: Sabine Arndt, Claas Fendler, Georg Hübner, Ludwig Kalthoff, Hans Jürgen Menne, Bernhard Mintrop, Annette Rittstieg, Ulrich Schoo, Frank Schumann, and Rakesh Sharma.

Funding

This study was supported by an unrestricted grant by Pfizer (Grant number WI 186174, Pfizer GmbH, Linkstr. 10, D-10785 Berlin, Germany).

Author information

Author notes

  1. Dietmar Krause and Carolin Krause contributed equally to this work.

Authors and Affiliations

  1. Rheumatology Practice, Gladbeck, Germany

    Dietmar Krause

  2. Department of Medical Informatics, Biometry and Epidemiology, Ruhr University, Bochum, Germany

    Dietmar Krause & Henrik Rudolf

  3. Department of Gastroenterology and General Internal Medicine, Evangelisches Krankenhaus Kalk, Cologne, Germany

    Carolin Krause

  4. Rheumazentrum Ruhrgebiet at Ruhr University, Bochum, Germany

    Xenofon Baraliakos & Jürgen Braun

  5. Rheumatology Practice, Hattingen, Germany

    Elmar Schmitz

Authors
  1. Dietmar Krause
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Contributions

ES, DK, XB, and JB conceived the study idea and designed the study. DK, ES, and CK reviewed the literature. HR and DK directed the analyses, which were carried out by HR. All authors participated in the discussion and interpretation of the results. CK organized the writing and wrote the initial drafts. All authors critically revised the manuscript for intellectual content and approved the final version.

Corresponding author

Correspondence to Dietmar Krause.

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Ethics approval

The ethics committee of Munster, Germany, had approved the study (registration number: 2018–208-f-S).

Consent to participate

Each patient had provided written informed consent.

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All authors provided consent to publish.

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The software application will be available on request.

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Krause, D., Krause, C., Rudolf, H. et al. Dose tapering of biologic agents in patients with rheumatoid arthritis—results from a cohort study in Germany. Clin Rheumatol 40, 887–893 (2021). https://doi.org/10.1007/s10067-020-05316-9

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  • DOI: https://doi.org/10.1007/s10067-020-05316-9

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