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Feel good? Skip your Meds... You Might be Just Fine!
November 9 2015 1:56 AM ET — via RheumReports
As more and more patients with RA reach sustained remission or low disease state, they want to know what would happen if they skipped their drugs or stopped them altogether. Strategies for dose reduction have been hot topics at our meetings over the past few years, and ACR 2015 is no exception. I suspect that many of our patients take their SC biologics on an 'as needed' basis... many more than we think! Furthermore, with the emphasis on cost containment and the arrival of subsequent entry biologics, perhaps we should be encouraging patients who are in remission to take their biologics PRN.
Today, researchers from Japan presented data evaluating outcomes in RA patients using PRN etanercept, followed for an average of 20 months. Eighteen biologic-naïve RA patients (DAS28>3.2) who failed MTX (mean dose 10mg/wk) and achieved a low disease state on etanercept 50mg weekly, had their etanercept stopped and used only as needed (on/off). Of these, five remained in low disease state without restarting etanercept. Of the 13 patients who required on/off etanercept dosing, the mean dose of etanercept was 10mg/wk, providing a cost savings of 28% across all patients.
The researchers then compared radiographic progression at 1 and 2 years in the on/off etanercept group (including the five who did not restart etanercept) to another group of RA patients with low disease activity who were taking regular doses of etanercept. There were no differences between the two groups. Not surprisingly, higher concurrent use of MTX (>8mg/wk) was a predictor of requiring less etanercept.
Reviewers would probably argue that this study had small numbers and the population is different than our Canadian population. Although I agree, I think that this provides us with interesting information. In addition to learning about dose reduction strategies, I think we need to look at PRN use of biologics (similar to what we do with rituximab) more closely... it may just be the wave of the future. I am pretty sure that both patients and payers would appreciate it!
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About the Author
Dr. Shahin Jamal
Dr. Jamal is a Clinical Associate Professor at the University of British Columbia and an active staff physician at Vancouver Coastal Health. Her interests include diagnosis and prognosis of early inflammatory arthritis, and timely assessment and access to care for patients with rheumatoid arthritis.
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