ARCTIC Rewind: Can You Taper DMARDs with Remission? Save

In an open-label, randomized, non-inferiority trial, rheumatoid arthritis (RA) patients in remission were subject to tapering of disease-modifying antirheumatic drugs (DMARDs), and while maintenance of remission was seen in some, many DMARD tapering patients did flare and were unable to maintain flare-free survival compared to those on stable conventional synthetic DMARDs (csDMARDs).

 

In this 3-year non-inferiority study of csDMARD tapering, 160 adults in remission were randomized to either 1) continue stable csDMARD; 2) reduce to half-dose csDMARDs, or 3) half-dose csDMARDs for 1 year followed by csDMARD withdrawal. The primary endpoint was disease flare over 3 years. The non-inferiority margin of 20%.

 

A total of 160 RA patients were randomized to stable csDMARDs (n=80), half-dose csDMARDs (n=42), or half-dose csDMARDs tapering to withdrawal (n=38). 155 patients were included in the per-protocol analysis and 139 completed 3-years follow-up without major protocol violation.

 

At the end of the 3-year study, flare-free results were seen in:

The results with the tapering regimens were beyond the non-inferiority margins for both the half-dose (23%) and withdrawal (40%) groups. Adverse events were similar between groups. 

 

These data demonstrate there is a significant risk of flare when embarking upon a csDMARD tapering strategy and informs the prescriber as to the potential risk and benefits of different treatment strategies in RA management.