Incidence of Flare in Patients with Rheumatoid Arthritis after Tapering Conventional Synthetic Disease-Modifying Antirheumatic Drugs

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Ampond Pitipakorn


Background: Conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) are used in rheumatoid arthritis (RA) to achieve a
remission or low disease activity at least 6 months. Thereafter, drug de-escalation is initiated to obtain the sustained drug free remission De-escalation of csDMARDs is a major cause of disease flare.

Objective: To determine an incidence rate of flare in patients with RA after csDMARDs tapering and the risk factors of flare.

Material and method: A retrospective cohort study was conducted among RA patients treated in Lampang Hospital with disease remission
or low disease activity at least 6 months and received csDMARDs de-escalation during January 2015 – March 2020. The event of first flare within 1 year after drug tapering was monitored. Data were compared between
the flare and non-flare groups. Risk factor of disease flare was analyzed using univariate regression analysis.

Results: Among 88 patients who underwent csDMARDs tapering, 17 patients (19.3%) had disease flare at the average of 202 days (SD 79). The median time of csDMARDs treatment before drug de-escalation in the flare group was shorter than the non-flare group (1 [IQR 1,2] year vs 2 [IQR 1,4] year, p=0.027). Longer duration of csDMARDs treatment before
drug de-escalation tended to decrease the risk of disease flare (OR 0.67, 95%CI 0.44−1.01, p=0.056), similarly with receiving ≥3 items of csDMARDs (OR 0.29, 95%CI 0.08−1.11, p=0.071)

Conclusion: The incidence of flare in patients with RA after tapering csDMARDs within one year was 19.3%. Longer duration of csDMARDs
treatment and receiving ≥3 items of csDMARDs before drug de-escalation tended to decrease the risk of disease flare.


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Pitipakorn, A. (2022). Incidence of Flare in Patients with Rheumatoid Arthritis after Tapering Conventional Synthetic Disease-Modifying Antirheumatic Drugs. Lampang Medical Journal, 43(1), 16–25. Retrieved from
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