Abstract
Background Tapering of anti-tumour necrosis factor (TNF)
therapy appears feasible, safe and effective in selected
patients with rheumatoid arthritis (RA). Depression is highly
prevalent in RA and may impact on flare incidence through
various mechanisms. This study aims to investigate if
psychological states predict flare in patients’ dose tapering
their anti-TNF therapy.
Methods This study is a post-hoc analysis of the Optimizing
TNF Tapering in RA trial, a multicentre, randomised, openlabel
study investigating anti-TNF tapering in RA patients with
sustained low disease activity. Patient-reported outcomes
(Health Assessment Questionnaire, EuroQol 5-dimension
scale, Functional Assessment of Chronic Illness Therapy
fatigue scale (FACIT-F), 36-Item Short Form Survey (SF-36))
were collected at baseline. The primary outcome was flare,
defined as an increase in 28-joint count Disease Activity
Score (DAS28) ≥0.6 and ≥1swollen joint. Discrete-time
survival models were used to identify patient-reported
outcomes that predict flare.
Results Ninety-seven patients were randomised to taper
their anti-TNF dose by either 33% or 66%. Forty-one patients
flared. Higher baseline DAS28 score was associated with
flare (adjusted HR 1.96 (95% CI 1.18 to 3.24), p=0.01).
Disability (SF-36 physical component score), fatigue
(FACIT-F) and mental health (SF-36 mental health subscale
(MH)) predicted flare in unadjusted models. In multivariate
analyses, only SF-36 MH remained a statistically significant
predictor of flare (adjusted HR per 10 units 0.74 (95% CI 0.60
to 0.93), p=0.01).
Conclusions Baseline DAS28 and mental health status
are independently associated with flare in patients who
taper their anti-TNF therapy. Fatigue and function also
associate with flare but the effect disappears when
adjusting for confounders. Given these findings, mental
health and functional status should be considered in antiTNF
tapering decisions in order to optimise the likelihood
of success.
therapy appears feasible, safe and effective in selected
patients with rheumatoid arthritis (RA). Depression is highly
prevalent in RA and may impact on flare incidence through
various mechanisms. This study aims to investigate if
psychological states predict flare in patients’ dose tapering
their anti-TNF therapy.
Methods This study is a post-hoc analysis of the Optimizing
TNF Tapering in RA trial, a multicentre, randomised, openlabel
study investigating anti-TNF tapering in RA patients with
sustained low disease activity. Patient-reported outcomes
(Health Assessment Questionnaire, EuroQol 5-dimension
scale, Functional Assessment of Chronic Illness Therapy
fatigue scale (FACIT-F), 36-Item Short Form Survey (SF-36))
were collected at baseline. The primary outcome was flare,
defined as an increase in 28-joint count Disease Activity
Score (DAS28) ≥0.6 and ≥1swollen joint. Discrete-time
survival models were used to identify patient-reported
outcomes that predict flare.
Results Ninety-seven patients were randomised to taper
their anti-TNF dose by either 33% or 66%. Forty-one patients
flared. Higher baseline DAS28 score was associated with
flare (adjusted HR 1.96 (95% CI 1.18 to 3.24), p=0.01).
Disability (SF-36 physical component score), fatigue
(FACIT-F) and mental health (SF-36 mental health subscale
(MH)) predicted flare in unadjusted models. In multivariate
analyses, only SF-36 MH remained a statistically significant
predictor of flare (adjusted HR per 10 units 0.74 (95% CI 0.60
to 0.93), p=0.01).
Conclusions Baseline DAS28 and mental health status
are independently associated with flare in patients who
taper their anti-TNF therapy. Fatigue and function also
associate with flare but the effect disappears when
adjusting for confounders. Given these findings, mental
health and functional status should be considered in antiTNF
tapering decisions in order to optimise the likelihood
of success.
| Original language | English |
|---|---|
| Article number | e000676 |
| Journal | RMD Open |
| Volume | 4 |
| Early online date | 17 May 2018 |
| DOIs | |
| Publication status | E-pub ahead of print - 17 May 2018 |
