Tapering Biologic Therapy for Rheumatoid Arthritis: A Qualitative Study of Patient Perspectives

Chan, Suz Jack; Stamp, Lisa K.; Liebergreen, Nicola; Ndukwe, Henry C.; Marra, Carlo A.; Treharne, Gareth J.

doi:10.1007/s40271-019-00403-9

Cited by 16 publications

(21 citation statements)

References 35 publications

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“…Physicians’ concerns include managing relapses, recapturing control with retreatment, and monitoring laboratory test progression (27,28). In a qualitative study assessing patients’ perspectives about decreasing medications, major concerns included recurrence of symptoms, disease progression, quality of life, and prompt access to health care for flares (17).…”

Section: Discussionmentioning

confidence: 99%

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Modifications in Systemic Rheumatic Disease Medications: Patients’ Perspectives During the Height of the COVID‐19 Pandemic in New York City

Mancuso

Duculan

Jannat‐Khah

et al. 2021

Arthritis Care & Research

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Objective Concerns about severe acute respiratory syndrome coronavirus 2 (SARS–CoV‐2) infection may have led to changes or discontinuation of immunosuppressive medications among patients with systemic rheumatic disease. Our goal was to assess patients’ perspectives regarding medication modifications and deviations from planned uses during the height of the pandemic. Methods Adult patients of 13 rheumatologists at an academic center with physician‐diagnosed rheumatic disease and prescribed disease‐modifying medications were interviewed by telephone and asked open‐ended questions about the impact of SARS–CoV‐2 on their medications. Responses were analyzed using content and thematic analyses to generate categories that described patterns of medication modification. Results A total of 112 patients (mean age 50 years, 86% women, 34% non‐White race or Latino ethnicity) with diverse diagnoses (30% lupus, 26% rheumatoid arthritis, 44% other) who were taking various medications were enrolled. Patients reported clinically relevant issues that were iteratively reviewed to generate unique categories of medication modification: medications and increased or decreased risk of SARS–CoV‐2 infection; role of hydroxychloroquine; maintaining medication status quo; role of glucocorticoids; increasing or decreasing existing medications in relation to clinical disease activity; postponing infusions; and medication plan if infected by SARS–CoV‐2. Some modifications were suboptimal for disease control but were made to mitigate infection risk and to minimize potential harm when patients were unable to obtain laboratory tests and physical examinations due to cessation of in‐person office visits. Conclusion During the height of the pandemic, substantial medication modifications were made that, in some cases, were temporizing measures and deviations from planned regimens. Future studies will assess short‐ and long‐term sequelae of these medication modifications.

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Section: Discussionmentioning

confidence: 99%

“…How do you think this might benefit/harm you? What did you and your rheumatologist talk about regarding COVID‐19 and your medications?” These questions were modeled after a qualitative study of RA patients’ perspectives about tapering medications (17).…”

Section: Methodsmentioning

confidence: 99%

Modifications in Systemic Rheumatic Disease Medications: Patients’ Perspectives During the Height of the COVID‐19 Pandemic in New York City

Mancuso

Duculan

Jannat‐Khah

et al. 2021

Arthritis Care & Research

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“…It may also relate to patients and/or rheumatologists' beliefs, fears and attitudes towards tapering. To date, qualitative research has focused solely on patient preferences and attitudes for tapering biologic therapy [12][13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Patient and rheumatologist perspectives on tapering DMARDs in rheumatoid arthritis: a qualitative study

et al. 2021

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Objectives To understand the perspectives of patients and rheumatologists for tapering DMARDs in RA. Methods Using semi-structured interview guides, we conducted individual interviews and focus groups with RA patients and rheumatologists, which were audiotaped and transcribed. We conducted a pragmatic thematic analysis to identify major themes, comparing and contrasting different views on DMARD tapering between patients and rheumatologists. Results We recruited 28 adult patients with RA (64% women; disease duration 1–54 years) and 23 rheumatologists (52% women). Attitudes across both groups towards tapering DMARDs were ambivalent, ranging from wary to enthusiastic. Both groups expressed concerns, particularly the inability to ‘recapture’ the same level of disease control, while also acknowledging potential positive outcomes such as reduced drug harms. Patient tapering perspectives (whether to and when) changed over time and commonly included non-biologic DMARDs. Patient preferences were influenced by lived experiences, side effects, previous tapering experiences, disease trajectory, remission duration, and current life roles. Rheumatologists’ perspectives varied on timing and patient profile to initiate tapering, and were informed by both data and clinical experience. Patients expressed interest in shared decision making (SDM) and close monitoring during tapering, with ready access to their healthcare team if problems arose. Rheumatologists were generally open to tapering (not stopping), though sometimes only when requested by their patients. Conclusion The perspectives of patients and rheumatologists on tapering DMARDs in RA vary and evolve over time. Rheumatologists should periodically discuss DMARD tapering with patients as part of SDM, and ensure monitoring and flare management plans are in place.

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“…When patients experienced flare-ups during biologics tapering, the treating physicians would pause the tapering attempt, escalate treatment to previous step, or even shift to alternative biologics in order to keep disease activity at inactive status. Further attempts at tapering might be considered with great prudence either by the treating physicians or patients themselves (16). Thus, patients with flare-ups during biologics tapering might receive a long period of follow-up with multiple stops and starts.…”

Section: Discussionmentioning

confidence: 99%

Tapering of Biological Agents in Juvenile ERA Patients in Daily Clinical Practice

2021

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Objectives: We aim to evaluate the proportion and characteristics of enthesitis-related arthritis (ERA) patients in whom medications can be withdrawn in daily practice and to analyze the factors associated with flare-ups during medication tapering of these patients.Methods: We retrospectively reviewed records of patients under 16 years old diagnosed with ERA from April 2001 to March 2020 in one tertiary medical center in Taiwan. Patients were categorized by different medication uses: conventional disease modifying anti-rheumatic drugs (cDMARDs) only and cDMARDs plus biologics. Demographics, laboratory data, presence of uveitis, and medication withdrawal rate were analyzed. Subgroup analysis was performed in the patients with cDMARDs plus biologics to identify factors associated with flare-ups during medication tapering of these patients. Statistical analysis was performed using R (v3.6.0).Results: There were 75 juvenile ERA patients with a median onset age of 10.28 years old. Nineteen (25.3%) patients used cDMARDs for disease control; 56 (74.7%) patients depended on cDMARDs plus biologics. Poly-articular involvement was noted in 29 (38.7%) patients, and it occurred more frequently in the cDMARDs plus biologics subgroup (cDMARDs only, 5.3%; cDMARDs plus biologics, 53.6%; P = 0.0001). ANA positivity was observed in 18 (24.0%) patients, and it occurred more frequently in the cDMARDs plus biologics subgroup (cDMARDs, 0%; cDMARDs plus biologics, 32.1%; P = 0.0038). The overall medication withdrawal rate was 34.7%, and it occurred more frequently in patients with cDMARDs only (cDMARDs only, 84.2%; cDMARDs plus biologics, 17.9%; P < 0.001). In the subgroup analysis of patients with cDMARDs plus biologics, patients on biologics tapering with flare-up had a significantly longer time interval between disease onset and initiation of cDMARDs (biologics tapering without flare-up: 0.27 (0.11–0.73) years; biologics tapering with flare-up: 1.14 (0.39–2.02) years; ever withdrawing biologics: 0.26 (0.18–0.42) years, P = 0.0104).Conclusion: Juvenile ERA patients with polyarticular involvement had a higher risk of developing cDMARDs refractory and progressing to biologics use. Patients with a long time interval between disease onset and initiation of cDMARDs were prone to experience flare-up during tapering of biologics.

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Tapering Biologic Therapy for Rheumatoid Arthritis: A Qualitative Study of Patient Perspectives

Cited by 16 publications

References 35 publications

Modifications in Systemic Rheumatic Disease Medications: Patients’ Perspectives During the Height of the COVID‐19 Pandemic in New York City

Modifications in Systemic Rheumatic Disease Medications: Patients’ Perspectives During the Height of the COVID‐19 Pandemic in New York City

Patient and rheumatologist perspectives on tapering DMARDs in rheumatoid arthritis: a qualitative study

Tapering of Biological Agents in Juvenile ERA Patients in Daily Clinical Practice

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