Physical Function of RA patients Tapering Treatment—A Post Hoc Analysis of the Randomized Controlled RETRO Trial

Stephan M, Tascilar K, Yalcin-Mutlu M, Hagen M, Haschka J, Reiser M, Hartmann F, Kleyer A, Hueber A, Manger B, Figueiredo C, Cobra JF, Tony HP, Finzel S, Kleinert S, Wendler J, Schuch F, Ronneberger M, Feuchtenberger M, Fleck M, Manger K, Ochs W, Schmitt-Haendle M, Lorenz HM, Nüsslein H, Alten R, Henes J, Krüger K, Schett G, Rech J (2023)

Publication Type: Journal article

Publication year: 2023

Journal

Journal of Clinical Medicine MDPI

Book Volume: 12

Article Number: 3723

Journal Issue: 11

DOI: 10.3390/jcm12113723

Abstract

Several studies have shown that tapering or stopping disease-modifying anti-rheumatic drugs (DMARDs) in rheumatoid arthritis (RA) patients in sustained remission is feasible. However, tapering/stopping bears the risk of decline in physical function as some patients may relapse and face increased disease activity. Here, we analyzed the impact of tapering or stopping DMARD treatment on the physical function of RA patients. The study was a post hoc analysis of physical functional worsening for 282 patients with RA in sustained remission tapering and stopping DMARD treatment in the prospective randomized RETRO study. HAQ and DAS-28 scores 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 HAQ and DAS-28 scores were evaluated every 3 months. The effect of treatment reduction strategy on functional worsening was assessed in a recurrent-event Cox regression model with a study-group (control, taper, and taper/stop) as the predictor. Two-hundred and eighty-two patients were analyzed. In 58 patients, functional worsening was observed. The incidences suggest a higher probability of functional worsening in patients tapering and/or stopping DMARDs, which is likely due to higher relapse rates in these individuals. At the end of the study, however, functional worsening was similar among the groups. Point estimates and survival curves show that the decline in functionality according to HAQ after tapering or discontinuation of DMARDs in RA patients with stable remission is associated with recurrence, but not with an overall functional decline.

Authors with CRIS profile

Koray Tascilar Department of Medicine 3 – Rheumatology and Immunology Melanie Hagen Department of Medicine 3 – Rheumatology and Immunology Arnd Kleyer Department of Medicine 3 – Rheumatology and Immunology Axel Hueber Department of Medicine 3 – Rheumatology and Immunology Bernhard Manger Professur für Rheumatologie und Klinische Immunologie Georg Schett Lehrstuhl für Innere Medizin III Hans Jürgen Rech Department of Medicine 3 – Rheumatology and Immunology

Involved external institutions

Karl Landsteiner Gesellschaft AT Austria (AT) Universitätsklinikum Freiburg DE Germany (DE) Kreiskliniken Altötting-Burghausen DE Germany (DE) Asklepios Kliniken Bad Abbach DE Germany (DE) Julius-Maximilians-Universität Würzburg DE Germany (DE) Universitätsklinikum Heidelberg DE Germany (DE) Schlosspark-Klinik DE Germany (DE) Eberhard Karls Universität Tübingen DE Germany (DE) LMU Klinikum DE Germany (DE)

How to cite

APA:

Stephan, M., Tascilar, K., Yalcin-Mutlu, M., Hagen, M., Haschka, J., Reiser, M.,... Rech, J. (2023). Physical Function of RA patients Tapering Treatment—A Post Hoc Analysis of the Randomized Controlled RETRO Trial. Journal of Clinical Medicine, 12(11). https://dx.doi.org/10.3390/jcm12113723

MLA:

Stephan, Marlene, et al. "Physical Function of RA patients Tapering Treatment—A Post Hoc Analysis of the Randomized Controlled RETRO Trial." Journal of Clinical Medicine 12.11 (2023).

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