LAUSR

Use of biologic disease-modifying anti-rheumatic drugs (bDMARDs) have revolutionised the management of rheumatoid arthritis (RA). However, their use is not without side effects including infection and malignancy risk. Recent EULAR and ACR guidelines support consideration of dose tapering in patients in sustained remission. This study looks at identifying predictive factors for successful bDMARD dose tapering, to help select patients who may benefit from it, whilst minimising the risk of flare. We searched our local biologic database retrospectively for RA patients who were dose tapered in line with our local guideline, between June 2015 and December 2021. 91 patients were identified, 17 patients were excluded due to death or cessation of bDMARD for unrelated reasons. Clinical and demographic data collected included: age, gender, rheumatoid factor and/or anti-cyclic citrullinated peptide antibody positivity, biologic choice, concurrent use of conventional synthetic DMARD (csDMARD), number of previous bDMARDs, and overall annual cost-saving. Incidence of flares after tapering and outcome after resuming original dose of biologic were noted. Of the 74 patients included, 39 (53%) were on rituximab, 14 (19%) were on etanercept , 11 (15%) were on certolizumab pegol, 9 (12%) were on adalimumab, and 1 (1%) was on tocilizumab. The incidence of flare is highest in the first 6 months after being tapered (47%; n = 18). Of those who flared (n = 38), 84% regained control following re-introduction of original dose. After tapering, 67% (n = 18/27) of patients aged 70-89 remained in remission whilst more than 50% (n = 29/47) flared in younger age groups. Patients on rituximab were more likely to remain in remission. There were no notable differences in gender, seropositivity and concurrent csDMARD use. Despite reduced cost of biologics through use of biosimilars, we are estimated to save £68,783 per annum from dose tapering. We find that patients in older age group or on rituximab have a higher chance of remaining in remission following bDMARD dose tapering. The risk of flare is not affected by gender, seropositivity or concurrent csDMARDs use. If patients were to flare post dose tapering, this is more likely to occur within the first 6 months after tapering. Disclosure M. Loh: None. C.J. Jones: Other; Received payment from Fresenius Kabi for participation in a focus group regarding publication of NICE TA 715. A. Peall: None. J. Trickey: None.