Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

Physical Function of RA patients tapering treatment: A Post-Hoc Analysis of the Randomized Controlled RETRO Trial

Version 1 : Received: 26 April 2023 / Approved: 27 April 2023 / Online: 27 April 2023 (03:29:35 CEST)

A peer-reviewed article of this Preprint also exists.

Stephan, M.; Tascilar, K.; Yalcin-Mutlu, M.; Hagen, M.; Haschka, J.; Reiser, M.; Hartmann, F.; Kleyer, A.; Hueber, A.J.; Manger, B.; Figueiredo, C.; Cobra, J.F.; Tony, H.-P.; Finzel, S.; Kleinert, S.; Wendler, J.; Schuch, F.; Ronneberger, M.; Feuchtenberger, M.; Fleck, M.; Manger, K.; Ochs, W.; Schmitt-Haendle, M.; Lorenz, H.M.; Nüsslein, H.; Alten, R.; Henes, J.; Krüger, K.; Schett, G.; Rech, J. Physical Function of RA patients Tapering Treatment—A Post Hoc Analysis of the Randomized Controlled RETRO Trial. J. Clin. Med. 2023, 12, 3723. Stephan, M.; Tascilar, K.; Yalcin-Mutlu, M.; Hagen, M.; Haschka, J.; Reiser, M.; Hartmann, F.; Kleyer, A.; Hueber, A.J.; Manger, B.; Figueiredo, C.; Cobra, J.F.; Tony, H.-P.; Finzel, S.; Kleinert, S.; Wendler, J.; Schuch, F.; Ronneberger, M.; Feuchtenberger, M.; Fleck, M.; Manger, K.; Ochs, W.; Schmitt-Haendle, M.; Lorenz, H.M.; Nüsslein, H.; Alten, R.; Henes, J.; Krüger, K.; Schett, G.; Rech, J. Physical Function of RA patients Tapering Treatment—A Post Hoc Analysis of the Randomized Controlled RETRO Trial. J. Clin. Med. 2023, 12, 3723.

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 analysed the impact of tapering or stopping DMARD treatment on the physical function of RA patients. The study was a posthoc 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, taper/stop) as the predictor. 282 patients were analysed. 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 functional decline after tapering or stopping DMARDs in RA patients with stable remission is small and related to relapses but to on overall functional decline.

Keywords

HAQ; Rheumatoid Arthritis; PROM`s; DMARD; DAS28

Subject

Medicine and Pharmacology, Clinical Medicine

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