Incidence of Flare in Patients with Rheumatoid Arthritis after Tapering Conventional Synthetic Disease-Modifying Antirheumatic Drugs
Article Sidebar
Main Article Content
Abstract
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.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
บทความที่ส่งมาลงพิมพ์ต้องไม่เคยพิมพ์หรือกำลังได้รับการพิจารณาตีพิมพ์ในวารสารอื่น เนื้อหาในบทความต้องเป็นผลงานของผู้นิพนธ์เอง ไม่ได้ลอกเลียนหรือตัดทอนจากบทความอื่น โดยไม่ได้รับอนุญาตหรือไม่ได้อ้างอิงอย่างเหมาะสม การแก้ไขหรือให้ข้อมูลเพิ่มเติมแก่กองบรรณาธิการ จะต้องเสร็จสิ้นเป็นที่เรียบร้อยก่อนจะได้รับพิจารณาตีพิมพ์ และบทความที่ตีพิมพ์แล้วเป็นสมบัติ ของลำปางเวชสาร
References
McInnes IB, Schett G. The pathogenesis of rheumatoid arthritis. N Engl J Med. 2011;365(23):2205–19.
Smolen JS, Landewé R, Breedveld FC, Dougados M, EmeryP, Gaujoux-Viala C, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs.
Ann Rheum Dis. 2010;1;69(6):964−75.
Gotzsche PC, Johansen HK. Short-term low-dose corticosteroids vs placebo and nonsteroidal antiinflammatory drugs in rheumatoid arthritis. Cochrane Database Syst Rev. 2004;2005(3):CD000189.
สมาคมรูมาติสซั่มแห่งประเทศไทย. แนวเวชปฏิบัติเพื่อการวินิจฉัยและการดูแลรักษาโรคข้ออักเสบรูมาตอยด์ [อินเทอร์เน็ต]. 2557 [เข้าถึงเมื่อ 22 มี.ค. 2565]. เข้าถึงได้จาก https://thairheumatology.org/index.php/learning-center/for-physician/forphysician-
?view=article&id=73:1-29&catid=16
Fraenkel L, Bathon JM, England BR, St.Clair EW, Arayssi T, Carandang K, et al. 2021 American college of rheumatology guideline for the treatment of rheumatoid arthritis. Arthritis Care Res. 2021;73(7):924–39.
Ajeganova S, Huizinga T. Sustained remission in rheumatoid arthritis: latest evidence and clinical considerations. Ther Adv Musculoskelet Dis. 2017;9(10):249–62.
Gul H, Harnden K, Saleem B. Defining the optimal strategy for achieving drug-free remission in rheumatoid arthritis : a narrative review. Healthcare (Basel). 2021;9(12):1726.
Kuijper TM, Lamers-Karnebeek FB, Jacobs JW, Hazes JM, Luime JJ. Flare rate in patients with rheumatoid arthritis in low disease activity or remission when tapering or stopping synthetic or biologic DMARD: a systematic review. J
Rheumatol. 2015;42(11):2012−22.
Haschka J, Englbrecht M, Hueber AJ, Manger B, Kleyer A, Reiser M, et al. Relapse rates in patients with rheumatoid arthritis in stable remission tapering or stopping antirheumatic therapy: interim results from the prospective randomised controlled RETRO study. Ann Rheum Dis. 2016;75(1):45–51.
van den Broek M, Lems WF, Allaart CF. BeSt practice: the success of early-targeted treatment in rheumatoid arthritis. Clin Exp Rheumatol. 2012;30(4 Suppl 73):S35−8.
Schett G, Emery P, Tanaka Y, Burmester G, Pisetsky DS, Naredo E, et el. Tapering biologic and conventional DMARD therapy in rheumatoid arthritis: current evidence and future directions. Ann Rheum Dis. 2016;75(8):1428−37.
ten Wolde S, Breedveld FC, Hermans J, Vandenbroucke JP, van de Laar MA, Markusse HM, et al. Randomised placebo-controlled study of stopping second-line drugs in rheumatoid arthritis. Lancet. 1996;347(8998):347–52,
Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988;31(3):315–24.
Kay J, Upchurch KS. ACR/EULAR 2010 rheumatoid arthritis classification criteria. Rheumatology (Oxford). 2012;51 Suppl 6:vi5−9.
Saag KG, Teng GG, Patkar NM, Anuntiyo J, Finney C, Curtis JR, et al. American College of Rheumatology 2008 recommendations for the use of nonbiologic and biologic disease-modifying antirheumatic drugs in rheumatoid arthritis. Arthritis Rheum. 2008;59(6):762–84.
Bechman K, Tweehuysen L, Garrood T, Scott DL, Cope AP, Galloway JB, et al. Flares in rheumatoid arthritis patients with low disease activity: predictability and association with worse clinical outcomes. J Rheumatol. 2018;45(11):1515–21.
Kuijper TM, Luime JJ, de Jong PHP, Gerards AH, van Zeben D, Tchetverikov I, et al. Tapering conventional synthetic DMARDs in patients with early arthritis in sustained remission: 2-year follow-up of the tREACH trial. Ann Rheum Dis.
;75(12):2119–23.
Markusse IM, Dirven L, Gerards AH, van G roenendael JH, Ronday HK, Kerstens PJ, et al. Disease flares in rheumatoid arthritis are associated with joint damage progression and disability: 10-year results from the BeSt study. Arthritis Res Ther. 2015;17(1):232.
Möttönen T, Hannonen P, Leirisalo-Repo M, Nissilä M, Kautiainen H, Korpela M, et al. Comparison of combination therapy with single-drug therapy in early rheumatoid arthritis : a randomized trial. Lancet. 1999;353(9164):1568−73.
Mäkinen H, Kautiainen H, Hannonen P, Möttönen T, Leirisalo-Repo M, Laasonen L, et al. Sustained remission and reduced radiographic progression with combination disease modifying antirheumatic drugs in early rheumatoid arthritis. J Rheumatol. 2007;34(2):316–21.
van der Helm-van Mil AH, Verpoort KN, Breedveld FC, Toes RE, Huizinga TW. Antibodies to citrullinated proteins and differences in clinical progression of rheumatoid arthritis. Arthritis Res Ther. 2005;7(5):R949−58.
Bukhari M, Thomson W, Naseem H, Bunn D, Silman A, Symmons D, et al. The performance of anti-cyclic citrullinated peptide antibodies in predicting the severity of radiologic damage in inflammatory polyarthritis: results from the Norfolk Arthritis Register. Arthritis Rheum. 2007:56(9):2929−35.
van der Woude D, Young A, Jayakumar K, Mertens BJ, Toes RE, van der Heijde D, et al. Prevalence of and predictive factors for sustained diseasemodifying antirheumatic drug-free remission in rheumatoid arthritis : result from two large early arthritis cohorts. Arthritis Rheum. 2009;60(8):2262-71.
van der Kooij SM, Goekoop-Ruiterman YP, de Vries-Bouwstra JK, Güler-Yüksel M, Zwinderman AH, Kerstens PJ, et al. Drug-free remission, functioning and radiographic damage after 4 years of response-driven treatment in patients
with recent-onset rheumatoid arthritis. Ann Rheum Dis. 2009;68(6):914−21.
Prince FH, Bykerk VP, Shadick NA, Lu B, Cui J, Frits M, et al. Sustained rheumatoid arthritis remission is uncommon in clinical practice. Arthritis Res Ther. 2012;14(2):R68.