One in six patients can stop taking medication completely, 80 percent can cut back
Patients with rheumatoid arthritis who have experienced little or no symptoms of their illness for at least six months, can gradually and safely reduce their medication.
They must, however, do this under the close supervision of their rheumatologist, so that at the first sign of a flare-up of the disease prescription can adjust again. This is evident from research by scientific researcher Dr. Elise van Mulligen, who obtained her PhD this week for her thesis ‘Different Viewpoints on Tapering DMARDs in Rheumatoid Arthritis’. By phasing out the medication of the more than 160,000 RA patients in the Netherlands, millions of euros can be saved. However, exactly how much is still difficult to determine at the moment.
The treatment of rheumatoid arthritis has improved greatly in recent years. Certainly the arrival of so-called biologicalseffective but expensive drugs that target the disease in a very targeted manner, has ensured that many patients hardly suffer from their condition. They usually use a combination of classic rheumatism and biologicals, with the result that the disease is quiet for longer periods.
Rheumatism medication
This raised the question of whether, and if so in what quantities, patients should continue to take their medication. After all, medicines often have side effects to a greater or lesser extent. In addition, biologicals are also expensive medicines.
To start with Van Mulligen’s final conclusion: of the 189 patients who took part in her so-called TARA trial, 80 percent succeeded in reducing the use of medication over a long period of time. Fifteen percent could even do without medication in the long term. After some time, 60 percent of the patients did develop a flare-up of the disease, after which the amount of medication had to be increased again – temporarily.
Van Mulligen compared two step-by-step taper strategies: one in which the classic rheumatism drug was tapered first (in many cases methotrexate), followed by the biologicals (TNFa inhibitors), and the strategy in which the expensive biologicals were tapered first and then the classic rheumatism.
In her recommendation, Van Mulligen writes that rheumatologists can best start their tapering strategy with tapering off the classic rheumatism drugs. ‘It doesn’t matter in terms of cost effectiveness. And because the patients in my study experience more side effects from the classic rheumatism drugs, I recommend that these drugs be tapered first. Certainly now that biologicals and biosimilars are becoming cheaper, and which appear to work very well for most patients. ‘
However, tapering off medication should be properly supervised by the rheumatologist, Van Mulligen observes. ‘Rheumatoid arthritis is unfortunately a chronic disease that cannot be cured yet. We know that stress or an infectious disease such as the flu can be a trigger for the disease to flare up. We have also seen that the Disease Activity Score deteriorates even before the patient actually flares up. A slight change in the DAS should lead to increased alertness in the rheumatologist. ‘
Source: ErasmusMC
–
