New measurements may allow dose reduction of DMARDS in rheumatoid arthritis

The combined use of two measurements to predict the risk of relapse in people with rheumatoid arthritis allows successful dose reduction of disease modifying anti-rheumatic drugs (DMARDs), experts revealed at a leading conference.

A combination of the multiple-biomarker disease activity (MBDA) score and anti-citrullinated protein (ACPA) status allowed the categorisation of different levels of relapse risk, which could be used to implement successful DMARD tapering.

With the development and wider use of DMARDs, about half of people with rheumatoid arthritis now achieve disease remission.

Previous research suggests that over half of people stay in remission after tapering or stopping conventional and biological DMARD treatment. Relapses occurred particularly in the first six months after treatment reduction, and were associated with the presence of ACPA. But prediction models for disease relapse based on ACPA alone needed further improvement.

“We have now been able to create a risk-stratified tapering model based on different relapse rates according to the use of MBDA and ACPA status as predictors,” explains Dr Melanie Hagen, lead author. “Having shown in the RETRO study that those rheumatoid arthritis patients who relapse after tapering their DMARDs respond well to their reintroduction, a structured tapering and stopping of DMARDs is not only a cost economic strategy, but also clinically feasible.”

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