Multiple-biomarker tool accurately predicts risk of relapse in rheumatoid arthritis patients in remission

In patients with rheumatoid arthritis (RA), the combination of the multiple-biomarker disease activity (MBDA) score and anti-citrulinated protein (ACPA) status may accurately predict the risk of relapse and allow for successful tapering of disease modifying anti-rheumatic drug (DMARD) therapy, according to results presented at the annual meeting of the European Congress of Rheumatology (EULAR 2017).

Thanks to DMARD therapy, approximately 50% of RA patients can achieve disease remission. But whether anti-rheumatic therapy can then be stopped or at least tapered, and predicting which patients are least likely to relapse are still unknown.

“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,” said lead author Melanie Hagen, MD, University of Erlangen-Nuremberg, Germany. “Having shown in the RETRO study that those RA 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,” she added.

Dr. Hagen and fellow researchers included 146 RA patients in sustained remission in whom MBDA scores and ACPA status were assessed from baseline serum samples. Patients were enrolled in the prospective randomized, controlled RETRO study. They either continued their current DMARD regimen, tapered the dose by 50%, or stopped DMARDs completed after 6 months of tapering.

Researchers observed patients for 1 year, and assessed direct treatment costs every 3 months.

The lowest risk of relapse (19%) was found in RA patients with low MBDA scores (< 30) and negative ACPA status. In those with moderate or high MBDA scores (≥ 30) or single positivity for ACPA, relapse risk increased, with the highest risk in those with double-positive ACPA (61%). Thus, DMARD tapering seemed feasible in patients with low MBDA and negative ACPA, and in those with moderate/high MBDA and negative ACPA.

When assessing only those RA patients who did not flare, costs for synthetic and biologic DMARDS in the 41 patients with low MBDA and single-positive ACPA would have been €123,751.29 for a full-dose treatment over 1 year. In the low-risk groups, tapering and discontinuation of DMARDS provided a 75% reduction in DMARD costs (€92,821.50).

In the low MBDA and negative ACPA and low MBDA and single-positive ACPA patients, the average cost reduction of DMARD therapy was €2,350.08. In those patients with moderate/high MBDA and single-positive ACPA, this average reduction was €1,761.43.