RT Journal Article
SR Electronic
T1 Cost-effective Tapering Algorithm in Rheumatoid Arthritis Patients: Combination of Multibiomarker Disease Activity Score and Autoantibody Status
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP jrheum.180028
DO 10.3899/jrheum.180028
A1 Melanie Hagen
A1 Matthias Englbrecht
A1 Judith Haschka
A1 Michaela Reiser
A1 Arnd Kleyer
A1 Axel Hueber
A1 Bernhard Manger
A1 Camille Figueiredo
A1 Jayme  Fogagnolo Cobra
A1 Hans-Peter Tony
A1 Stephanie Finzel
A1 Stefan Kleinert
A1 Jörg Wendler
A1 Florian Schuch
A1 Monika Ronneberger
A1 Martin Feuchtenberger
A1 Martin Fleck
A1 Karin Manger
A1 Wolfgang Ochs
A1 Hans-Martin Lorenz
A1 Hubert Nüsslein
A1 Rieke Alten
A1 Jörg Henes
A1 Klaus Krüger
A1 Georg Schett
A1 Jürgen Rech
YR 2018
UL http://www.jrheum.org/content/early/2018/11/26/jrheum.180028.abstract
AB Objective To analyze the effect of a risk-stratified disease-modifying antirheumatic drug (DMARD)–tapering algorithm based on multibiomarker disease activity (MBDA) score and anticitrullinated protein antibodies (ACPA) on direct treatment costs for patients with rheumatoid arthritis (RA) in sustained remission. Methods The study was a posthoc retrospective analysis of direct treatment costs for 146 patients with RA in sustained remission tapering and stopping DMARD treatment, in the prospective randomized RETRO study. MBDA scores and ACPA status were determined in baseline samples of patients continuing DMARD (arm 1), tapering their dose by 50% (arm 2), or stopping after tapering (arm 3). Patients were followed over 1 year, and direct treatment costs were evaluated every 3 months. MBDA and ACPA status were used as predictors creating a risk-stratified tapering algorithm based on relapse rates. Results RA patients with a low MBDA score (< 30 units) and negative ACPA showed the lowest relapse risk (19%), while double-positive patients showed high relapse risk (61%). In ACPA-negative and MBDA-negative (< 30 units), and ACPA or MBDA single-positive (> 30 units) groups, DMARD tapering appears feasible. Considering only patients without flare, direct costs for synthetic and biologic DMARD in the ACPA/MBDA-negative and single positive groups (n = 41) would have been €372,245.16 for full-dose treatment over 1 year. Tapering and stopping DMARD in this low-risk relapse group allowed a reduction of €219,712.03 of DMARD costs. Average reduction of DMARD costs per patient was €5358.83. Conclusion Combining MBDA score and ACPA status at baseline may allow risk stratification for successful DMARD tapering and cost-effective use of biologic DMARD in patients in deep remission as defined by the 28-joint count Disease Activity Score using erythrocyte sedimentation rate.