Tapering DMARDs May Lead to Disease Flare in Patients with RA Remission: JAMA
Sustained remission has become an achievable goal for patients with rheumatoid arthritis (RA). In a recent study, researchers have found that cut half dose of conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) during remission of rheumatoid arthritis (RA) might lead to more disease flare. The study findings were published in the JAMA on May 4, 2021.
Remission is the treatment target in RA However, the knowledge about the best way to treat RA patients who achieve sustained remission is limited. Therefore, Dr Siri Lillegraven and colleagues conducted a study to assess the effect of tapering of csDMARDs, compared with continuing csDMARDs without tapering, on the risk of flares in patients with RA in sustained remission.
The ARCTIC REWIND study was a multicenter, randomized, parallel, open-label noninferiority study conducted in 10 Norwegian hospital-based rheumatology practices. The researchers included a total of 160 patients with RA in remission for 12 months who were receiving stable csDMARD therapy. Researchers randomly assigned 160 patients to receive half-dose csDMARDs (n = 80) or stable-dose csDMARDs (n = 80). The major outcome assessed was the proportion of patients with a disease flare between baseline and the 12-month follow-up, defined as a combination of Disease Activity Score (DAS) greater than 1.6 (the threshold for RA remission), an increase in DAS score of 0.6 units or more, and at least 2 swollen joints. They determined the risk difference of 20% as the noninferiority margin.
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