Can RA Patients with Sustained Disease Control Taper Drug Doses?

Some rheumatoid arthritis (RA) patients may be able to taper to a lower dose of baricitinib and still manage the disease, according to new research. 

A new study was conducted using patients who received 4 mg of baricitinib for ≥ 15 months and maintained Clinical Disease Activity Index (CDAI) low disease activity (LDA) or remission (REM). For 48 weeks, participants either continued receiving 4 mg or were tapered to 2 mg of baricitinib. 

Patients in the 4 mg group were more likely to maintain LDA (4 mg, 80%; 2 mg, 67%) and REM (4 mg, 40%; 2 mg, 33%). The tapered dose group had more disease activity at 12, 24, and 48 weeks, as well as earlier and more frequent relapse, than the 4 mg group (4 mg, 23%; 2 mg, 37%; p = 0.001). Dose reduction was also associated with greater rescue rates (4 mg, 10%; 2 mg, 18%). The rate of non-serious infections was lower in the 2 mg group (4 mg, 30.6; 2 mg, 24.9). Researchers did not observe differences in serious adverse events and adverse events linked to discontinuation of baricitinib between the groups. 

The researchers concluded, “In a large randomised, blinded phase 3 study, maintenance of RA control following induction of sustained LDA/REM with baricitinib 4 mg was greater with continued 4 mg than after taper to 2 mg. Nonetheless, most patients tapered to 2 mg could maintain LDA/REM or recapture with return to 4 mg if needed.” 

Is It Rheumatoid Arthritis … or Something Else? 

Inflammation in Rheumatoid Arthritis: A Multi-modal MRI Study 

Tumor Necrosis Factor Inhibitors and Cancer Recurrence in Patients With Rheumatoid Arthritis 

Rheumatoid Arthritis and the Mucosal Origins Hypothesis 

Source: The BMJ