NEW YORK (Reuters Health)—For rheumatoid arthritis (RA) patients in stable remission, a panel of inflammatory markers in blood can help predict the odds of relapse when disease-modifying anti-rheumatic drug (DMARD) therapy is tapered, say researchers from Germany.
The multibiomarker disease activity (MBDA) score, when combined with anticitrullinated protein antibody (ACPA) testing, can predict relapse in more than 80% of the patients, Dr. Georg Schett from University Clinic of Erlangen-Nuremberg and colleagues found.
“Tapering DMARDs including biological agents like TNF blockers is feasible in RA patients who are in remission for at least six months, and there are markers which can tell clinicians and patients about the risk for the relapse of disease when tapering DMARDs,” Dr. Schett tells Reuters Health by e-mail.
“This approach allows optimization of RA treatment and prevents overtreatment in certain patient groups. It gives a strategy and guidance in RA patients in remission. CCP antibody testing and MBDA testing are widely available in routine care in the U.S. Therefore, this strategy is ready for use,” he says.
In the recently reported RETRO study, recurrence of disease was higher in patients tapering or stopping DMARDs than in those remaining on treatment. But it was “stunning that more than half of the patients still kept their remission state despite tapering the DMARDs,” Dr. Schett and colleagues note in a report online on Dec. 11 in Annals of the Rheumatic Diseases.
They determined MBDA scores based on 12 inflammation markers in baseline serum samples for 94 RETRO study subjects. They compared MBDA scores in patients relapsing or staying in remission during DMARD taper.
One-third of the patients had moderate-to-high MBDA scores (30 or higher on a scale of 1-100). Twice as many patients who relapsed had moderate/high MBDA compared with patients who remained in remission (58% vs. 21%), the researchers found.
In multivariate regression analysis, MBDA score was an independent predictor for relapse in addition to ACPA status.
“Relapse rates were low (13%) in patients who were MBDA-/ACPA-, moderate in patients who were MBDA+/ACPA- (33.3%) and MBDA-/ACPA+ (31.8%) and high in patients who were MBDA+/ACPA+ (76.4%),” the researchers report.
“We show,” they write in their paper, “that the presence of residual inflammation assessed by a standardized panel of biomarkers is associated with a higher relapse rate of RA when DMARDs are tapered or stopped. Our data suggest that (a) markers of inflammation are elevated in a subset of patients with RA in clinical remission and (b) that these patients are at higher risk for relapse if their anti-inflammatory treatment is reduced. Furthermore, assessment of residual inflammatory activity allows refinement of prediction models for relapses during DMARD tapering, if combined with the assessment of ACPA status. Hence, more than 80% of the relapses could be predicted when using MBDA scores in conjunction with ACPA testing.”
The researchers say the increased prevalence of relapses in patients with elevated MBDA scores “may reflect subclinical inflammation at the target tissue level such as residual synovitis or osteitis. It is conceivable that inflammation in these patients is effectively suppressed by DMARDs at the clinical level but has not completely resolved. Hence, tapering of DMARDs may permit recurrence of inflammatory disease activity associated with clinical relapse. In contrast, patients having low MBDA scores may indeed experience true resolution of inflammation, which lowers the risk for disease relapse if DMARDs are tapered. Our data suggest that MBDA scores are more effective than clinical scores in prediction of disease relapses.”
The MBDA blood test is marketed in the U.S. as Vectra DA by Crescendo Bioscience, Myriad Genetics.
The study had no commercial funding and the authors declared no competing interests.
Revised by the editors of The Rheumatologist on 1/12/2016 to correct relapse rate information.
