Disease activity-guided dose optimisation including discontinuation of TNF-inhibitors in rheumatoid arthritis is effective for up to 10 years: an observational follow-up of the DRESS study

Céleste J T van der Togt; Nathan den Broeder; Marleen S Boonstra; Aatke van der Maas; Alfons A den Broeder; Noortje van Herwaarden

doi:10.1093/rheumatology/keae103

Disease activity-guided dose optimisation including discontinuation of TNF-inhibitors in rheumatoid arthritis is effective for up to 10 years: an observational follow-up of the DRESS study

Rheumatology (Oxford). 2024 Feb 12:keae103. doi: 10.1093/rheumatology/keae103. Online ahead of print.

Authors

Céleste J T van der Togt^{1

2}, Nathan den Broeder^{1

2}, Marleen S Boonstra², Aatke van der Maas², Alfons A den Broeder², Noortje van Herwaarden^{2

3}

Affiliations

¹ Department of Rheumatology, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, the Netherlands.
² Department of Rheumatology, Sint Maartenskliniek, Ubbergen, the Netherlands.
³ Division of Pharmacology and Toxicology, Department of Pharmacy, Radboud University Medical Centre, Nijmegen, The Netherlands.

PMID: 38346712
DOI: 10.1093/rheumatology/keae103

Abstract

Objectives: To investigate safety and effectiveness of disease activity-guided dose optimisation of TNF-inhibitors in rheumatoid arthritis over 10 years.

Methods: Observational long-term extension of a randomised study of participants who completed the 3-year extension of the DRESS-study. After the randomised phase (month 0-18), disease activity-guided dose optimisation was allowed for all. Main outcomes were mean time-weighted DAS28-CRP; biological and targeted synthetic anti-rheumatic drug (b/tsDMARD) use per year as proportion of daily defined dose; proportion of patients reaching discontinuation; durability, effectiveness of subsequent dose reduction attempts; and radiographic progression between 3 and 10 years using the Sharp-van der Heijde score.

Results: 170 patients were included of whom 127 completed 10-year follow-up. The mean disease activity remained low (DAS28-CRP 2.13, 95% confidence interval 2.10-2.16), whilst the b/tsDMARD dose reduced from 97% at baseline (95%CI 96% to 99%, n = 170)% to56% at year 10 (49% to 63%, n = 127). 119 of 161 participants (74%) with an optimisation attempt reached discontinuation, with a median duration of 7 months (interquartile range 3-33 months), and 25 participants never had to restart their b/tsDMARD (21%, 14% to 29%). The mean dose reduction after dose optimisation was 48% (n = 159) for the first optimisation attempt and 33% for subsequent attempt (n = 86). 48% (41/86) of participants had radiographic progression exceeding the smallest detectable change (5.7 units), and progression was associated with disease activity, not b/tsDMARD use.

Conclusion: Long-term disease activity-guided dose optimisation of TNF-inhibitors in rheumatoid arthritis, including discontinuation and multiple tapering attempts, remains safe and effective.

Keywords: Rheumatoid arthritis; TNF-inhibitors; adalimumab; biologicals; dose reduction; etanercept; tapering.