AB0403 PREDICTORS OF PERSISTENCE OF BIOLOGIC DRUG STEP-DOWN STRATEGIES IN INFLAMMATORY ARTHRITIS: A LONGITUDINAL STUDY IN CLINICAL PRACTICE WITH A LONG FOLLOW-UP
Authors: Sebastian C. Rodriguez-García, Raul Castellanos-Moreira, Victoria Hernandez, Jose Inciarte, Virginia Ruiz-Esquide, Jose A. Gómez-Puerta, Raimón Sanmartí
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Recommendations for the management of Rheumatoid Arthritis (RA) and spondyloarthritis (SpA) with bDMARD include dose-tapering as an adequate option for patients on persistent remission. Although data regarding these strategies has increased in recent years, there is scarce evidence about their long-term effect. <h3>Objectives</h3> Our aim was to analyze the persistence of bDMARD dose-reduction in clinical practice and evaluate its predictors in patients with RA and SpA <h3>Methods</h3> Retrospective longitudinal study from 2006 to 2018. From a cohort of 153 patients with chronic inflammatory arthrititis treated with bDMARD (TNF inhibitors, rituximab, tocilizumab, and abatacept) we recruited those with RA and SpA receiving reduced-dose regimens.<sup>1</sup> Variables analyzed were: persistence of bDMARD dose-reduction, predictors of this persistence reported in the literature such as treatment with glucocorticoids (GC) or conventional synthetic DMARD (csDMARD), disease activity and duration of disease at dose-reduction as well as demographic and other clinical features. A Cox proportional hazards model was used to identify factors associated with persistence on reduced-doses during the study period. <h3>Results</h3> 56 patients (RA:33; SpA:23) on tapered bDMARD (etanercept 51.8%, adalimumab 32.1%, Infliximab 3.6% and tocilizumab 12.5%) at study entry were included. Their clinical and laboratory features are shown in table 1. After a mean follow-up on tapered-dose of 4.4 years (range 0.35-8.72), 42.9% of subjects overall remained on reduced doses (RA: 36.4%; SpA: 52.2%). (<i>Fig.1</i>) From those who required discontinuation of the step-down regimen, 16 (48.4%) achieved the therapeutic objective and 7 (22.6%) failed after returning to standard dose respectively. bDMARD were discontinued in 4 (12.9%) patients due to sustained disease remission (RA=3; SpA=1), 3 (9.7%) due to adverse events and 2 (6.4%) due to other reasons. No significant differences in the variables analyzed were found between patients continuing vs discontinuing reduced-dose regimens. After adjusting for age, sex, diagnosis and disease duration, the concurrent use of GC at the time of dose-reduction was an independent predictor of discontinuation of the step-down regimen [aHR 3.6 (1.4 – 9.3)] <h3>Conclusion</h3> A significant proportion of patients with RA and SpA (36.4% and 52.2% respectively) can be maintained with reduced doses of bDMARD after a long-term follow-up. Concurrent use of GC at the time of dose-reduction was found an independent predictor of discontinuation of the step-down regimen. <h3>References</h3> [1] Inciarte-Mundo J, et al. Reumatol Clin. 2014;10(1):10–16 <h3>Disclosure of Interests</h3> Sebastian C Rodriguez-García: None declared, Raul Castellanos-Moreira Speakers bureau: MSD, Lilly, Victoria Hernandez: None declared, Jose Inciarte Employee of: Lilly, Virginia Ruiz-Esquide Speakers bureau: Sanofi, Lilly, MSD, Jose A. Gómez-Puerta Consultant for: Pfizer, Roche, Speakers bureau: Abbvie, BMS, Janssen, MSD, Pfizer, Roche, Raimón Sanmartí Speakers bureau: PFIZER, SANOFI, LILLY, MSD, UCB, NOVARTIS, JANSSEN