NEW YORK (Reuters Health)—In patients with rheumatoid arthritis (RA), disease-activity-guided dose reduction of a tumor necrosis factor inhibitor (TNFi) is safe and effective in the long-term and leads to a large reduction in TNFi use, according to three-year data from the DRESS study.
Implementation of this strategy would “vastly improve the cost-effective use of TNFi,” conclude Dr. Chantal Bouman, of Sint Maartenskliniek, Nijmegen, the Netherlands, and colleagues.
In the DRESS (Dutch Dose Reduction Strategy of Subcutaneous TNF Inhibitors) study, patients were randomly allocated to a disease-activity-guided TNFi dose-reduction (DR) strategy or usual care (a standardized treat-to-target protocol aimed at maintaining low disease activity). The DR strategy consisted of a stepwise increase in the injection time interval every three months until flare or discontinuation.
The DRESS study, published in The BMJ in 2015 (https://www.ncbi.nlm.nih.gov/pubmed/25858265), showed that DR of TNFi therapy (adalimumab or etanercept) is non-inferior to usual care (UC) regarding flares. At 18 months, a major flare had occurred in 12% of the DR group versus 10% of the UC group.
In Annals of the Rheumatic Diseases, online June 12, the team reports three-year data of an extension of the DRESS study, in which the original group allocation was maintained.
Mirroring the original study findings, the safety and efficacy of the DR strategy was maintained up to three years in the extension phase which included 172 of the 180 original patients.
The cumulative incidence of major flare was 10% in the DR group and 12% in the UC group in the extension phase (18 to 26 months), and 17% and 14%, respectively, from 0 to 36 months.
The cumulative incidences of short-lived flares were 43% and 35% in DR and UC groups in the extension phase, and 83% and 44% from 0 to 36 months.
“No relevant difference in the number of major flares could be demonstrated between DR and UC group, and disease activity, functioning and quality of life were also very similar,” the researchers report.
They conclude that a “disease activity-guided DR strategy of TNFi in patients with RA doing well seems a reasonable long-term approach in RA treatment. Further optimization of this strategy could consist of identification of predictors for successful DR or discontinuation, as this might prevent short-lived flaring.”
The study received no commercial funding. Several authors reported ties to pharmaceutical companies.
Reference
- Bouman CA, Herwaarden NV, van den Hoogen FH, et al. Long-term outcomes after disease activity-guided dose reduction of TNF inhibition in rheumatoidarthritis: 3-year data of the DRESS study – a randomised controlled pragmatic non-inferioritystrategy trial. Annals of Rheumatic Diseases. 2017 Jun 12. [Epub ahead of print]
