SAT0160 PREFERENCES OF EUROPEAN RHEUMATOLOGISTS ON THE DISCONTINUATION OF BIOLOGICAL DISEASE-MODIFYING ANTIRHEUMATIC DRUGS IN PATIENTS WITH RHEUMATOID ARTHRITIS
Authors: Lukas Schlager, Michaela Loiskandl, Daniel Aletaha, Helga Radner
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> The introduction of biologic disease-modifying antirheumatic drugs (bDMARDs) revolutionized the treatment of rheumatoid arthritis (RA) and made remission (REM) or low disease activity (LDA) a realistic goal for most patients. It was shown that the discontinuation of bDMARDs in patients in REM or LDA is feasible (1,2) and that the physician's opinion plays an important part in the decision to discontinue (3). However, there is no reliable way of identifying patients who would benefit from bDMARD discontinuation after reaching REM or LDA. <h3>Objectives</h3> To identify the preference of rheumatologists regarding different parameters while discontinuing a bDMARD in their patients. <h3>Methods</h3> A systematic literature review was conducted with the aim of identifying predictors of successful bDMARD discontinuation in RA patients in REM or LDA. These predictors were then adapted into general parameters and sorted into different categories: patient demographics (n=6), disease activity (n=6), patient reported outcomes (n=6), treatment related parameters (n=5), laboratory parameters (n=6) and imaging parameter (n=5). Those parameters were reviewed by an expert panel and then distributed to rheumatologists in Europe. Rheumatologists were asked to state whether they find the presented parameter important to support their decision to discontinue bDMARD therapy or not. They also had the opportunity to state parameters they consider important. <h3>Results</h3> 313 rheumatologists from 29 different European countries responded. Most of the participants have been practicing for 10 to 20 years and see 10 to 25 RA patients per week. The majority of the parameters were considered important by the participants, with 19 out of the 34 presented parameters being considered important by ≥ 70%. The most commonly considered parameters were (percentage of participants who considered the parameter important): Time in REM or LDA (99%), c-reactive protein (96%), swollen joint count (93%), concomitant conventional synthetic DMARD therapy (93%) and disease activity score – 28 joints (90%). The least commonly considered parameters were: simplified disease activity score (48%), gray scale positivity (47%), rheumatoid factor (41%), smoking status (35%), gender (13%), interleukin-6 (9%) and shared epitope (8%). An overview of responses is given in figure 1 and figure 2. The most frequently mentioned parameter in the comments was the patient's opinion on discontinuation (n=28). <h3>Conclusion</h3> Rheumatologists appear to be very diligent in the things they consider when discontinuing bDMARDs in their patients. 19 of the 34 parameters have been considered important by ≥ 70% of participants. This might be because the presented parameters were based on predictors of successful discontinuation. This data gives insight into the current state of bDMARD discontinuation and can be used in further research to help identifying patients who would benefit from bDMARD discontinuation. <h3>References</h3> [1] van den Broek M, Klarenbeek NB, Dirven L, van Schaardenburg D, Hulsmans HM, Kerstens PJ, et al. Discontinuation of infliximab and potential predictors of persistent low disease activity in patients with early rheumatoid arthritis and disease activity score-steered therapy: subanalysis of the BeSt study. Annals of the rheumatic diseases. 2011;70(8):1389-94. [2] Tanaka Y, Yamanaka H, Ishiguro N, Miyasaka N, Kawana K, Kimura J, et al. Low disease activity for up to 3 years after adalimumab discontinuation in patients with early rheumatoid arthritis: 2-year results of the HOPEFUL-3 Study. Arthritis Res Ther. 2017;19(1):56. [3] Strand V, Miller P, Williams SA, Saunders K, Grant S, Kremer J. Discontinuation of Biologic Therapy in Rheumatoid Arthritis: Analysis from the Corrona RA Registry. Rheumatol Ther. 2017;4(2):489-502. <h3>Disclosure of Interests</h3> Lukas Schlager: None declared, Michaela Loiskandl: None declared, Daniel Aletaha Grant/research support from: AbbVie, Bristol-Myers Squibb, and MSD, Consultant for: AbbVie, Bristol-Myers Squibb, Eli Lilly, Janssen, Medac, Merck, MSD, Pfizer Inc, Roche, and UCB, Speakers bureau: AbbVie, Bristol-Myers Squibb, Eli Lilly, Janssen, Medac, Merck, MSD, Pfizer Inc, Roche, and UCB, Helga Radner: None declared