AB0426 Biologic Spacing in Rheumatoid Arthritis Patients in Persistent Disease Activity Control: A Real Life Experience
Authors: M. Todoerti, F. De Nard, S. Breda, S. Monti, V. Grosso, F. Inverardi, R. Caporali, C. Montecucco
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> Actually, as suggested from current therapeutic guidelines, tapering of biologic agents (bDMARDs) seems a feasible option in subsets of rheumatoid arthritis (RA) patients in persistent clinical disease control [1]. However definite step-down schedules are far to be fully elucidated due to the heterogeneity of available data in controlled trials. Data on real life contests are even fewer. <h3>Objectives</h3> To analyze the feasibility of bDMARD spacing in maintaining clinical disease control in real life RA patients in persistent low disease activity (LDA) or remission. To monitor sub-clinical signs of disease activity during bDMARDs tapering. <h3>Methods</h3> RA patients in persistent clinical disease control (at least LDA according to DAS28 score for at least 6 months) underwent current bDMARD (anti-TNF/no anti-TNF agents for at least 1 year) spacing (doubling of the inter-administration time); concomitant co-medications (conventional synthetic DMARDs/csDMARDs and/or low dose oral corticosteroids/CS) were carried on at stable dosages. Clinical and ultrasonographic (US) assessments were performed bi-monthly over initial 6 months period in order to define clinical relapse (&gt; LDA) and to monitor clinical and sub-clinical signs of inflammation (Gray scale, GS, and power Doppler, PD scores detected on hand and wrist US examination). Results about first 4 months of follow up are yet available for preliminary analysis. <h3>Results</h3> Globally, 35 patients met the criteria and agreed to the spacing. Most of them had an established disease (mean duration ± sd 11,92±7,80 years) with markers of poor prognosis (57% seropositive patients, 60% patients with erosive disease). They were generally on their first anti-TNF bDMARD therapy (30 anti-TNF, 4 tocilizumab, 1 abatacept) together with csDMARDs co-medication (29/35 patients); they were mostly CS free (28/35 cs-free patients; 7 patients on low dose oral CS). Over 4 months of observation DAS28 score did not significantly change (mean value ± sd from 1,92±0,59 to 1,89±0,63, p not significant), as happened for GS score (median [IQR] from 9 [8-12] to 11 [9-13], p not significant). Median PD score [IQR] significantly increase over time, from 0 [0-0] at baseline examination to 1,5 [0-4] (p=0,01) at 4 months. In 4 months, globally 2 patients relapsed. <h3>Conclusions</h3> Biologic DMARDs spacing might be a possible therapeutic option in real life RA patients in persistent disease control: despite the substantial increase in PD score, few patients clinically relapsed in the first months of observation. For a complete evaluation, risk-to-benefit issues should involve long-term clinical, functional and structural outcomes, along with safety and financial issues too. Predictive factors need to be fully elucidated to target patients who might benefit more from this strategy. <h3>References</h3> Smolen JS, et al. Ann Rheum Dis 2014;73:492–509. <h3>Disclosure of Interest</h3> None declared