SAT0115 FLARING OF RHEUMATOID ARTHRITIS DUE TO TAPERING OF DMARDS: HOW DOES IT AFFECT PATIENTS’ WELL-BEING? A STUDY ON PATIENT REPORTED OUTCOMES
Authors: Elise van Mulligen, Angelique Weel, Martijn Kuijper, Johanna Hazes, Annette van der Helm - van Mil, Pascal de Jong
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Previous studies have shown that it is possible to taper DMARDs in RA patients with an inactive disease, but this is accompanied with a higher chance of disease flares. Current recommendations advise to taper DMARDs from a clinical viewpoint. However, data on the feasibility of tapering DMARDs from a patient's perspective are sparse. <h3>Objectives:</h3> To determine the impact of flare after DMARD-tapering on patients quantifying the changes in patient relevant domains e.g. functional ability, fatigue, quality of life, and worker productivity, and to explore the duration of the effect. <h3>Methods:</h3> Data were used from all 113 patients that flared after tapering DMARDs in the TARA study, a multicenter randomised controlled trial in which patients in sustained remission (DAS&lt;2.4&amp;SJC&lt;1) tapered either their csDMARDs or TNF-inhibitor per protocol. For the current analysis, we compared the following secondary outcomes before and after flare over time; DAS44, functional ability (HAQ-DI), fatigue (BRAF-MDQ), quality of life (EQ-5D and SF36), anxiety and depression (HADS), morning stiffness, VAS general health, and worker productivity. Follow-up started three months before flare, at the moment of flare, and every 3 months thereafter. These were compared to baseline values, calculated by taking the average of 12, 9 and 6 months before flare. We used Linear Mixed Models (LMMs) with a random intercept and an autoregressive covariance matrix to determine an overall effect of flare. We adjusted for multiple testing with a Bonferroni correction. For determining the duration of the effect of a flare, we tested if the separate time points differed from the baseline with the same model. For the worker productivity we used descriptive statistics. <h3>Results:</h3> In total, 113 patients experienced a flare. Patients who had a flare had a less stable course of the outcomes over time, compared with patients without flare (Figure 1A-G). When comparing all time points to baseline, statistical significant differences were found for DAS44 (p&lt;0.0001), VAS general health (p&lt;0.0001), morning stiffness (p&lt;0.0001), HAQ-DI (p=0.0002), EQ-5D (p&lt;0.0001), BRAF-MDQ (p=0.04), and the SF36 physical component scale (p=0.0004) (Figure 1A-H). The duration of these effects was more than 12 months for the DAS44, morning stiffness, and VAS general health. For the HAQ-DI, EQ5D, BRAF-MDQ, and SF36 PCS the duration of the effect of a flare was 6 months (Figure 1H). The effect sizes, expresses as differences with baseline, are indicated in Figure 1H and were rather small for most outcomes. The number of patients with payed work and unemployment were not affected by flare. The amount of sick leave increased from 1 to 1.3 days per month in the 6 months after flare and productivity decreased 1 point on a 0-10 scale in the 3 months after flare. <h3>Conclusion:</h3> Having a flare does affect patient reported outcomes. It affects DAS44, VAS general health, morning stiffness, functional ability, quality of life, and fatigue. This effect lasted for more than 6 months. Although we only found minor differences with baseline on group level, on the individual patient level this can still be of great importance. <h3>Disclosure of Interests:</h3> Elise van Mulligen: None declared, Angelique Weel: None declared, Martijn Kuijper: None declared, Johanna Hazes: None declared, Annette van der Helm - van Mil Grant/research support from: The research leading to these results has received funding from the European Research Council (ERC) under the European Union's Horizon 2020 research and innovation programme (Starting grant, agreement No 714312) and from the Dutch Arthritis Foundation. The funding source had no role in the design and conduct of the study., Pascal de Jong: None declared