PharmacoEconomics & Outcomes News | 2019
Algorithm for DMARD tapering reduces drug costs
Abstract
A risk-stratified algorithm based on multibiomarker disease activity (MBDA) score and anticitrullinated protein antibodies (ACPA) status appears to be effective for tapering disease-modifying antirheumatic drugs (DMARDs) and reduces drug costs in patients with rheumatoid arthritis (RA) in sustained remission, according to findings of a German study published in The Journal of Rheumatology. This posthoc analysis of data for 146 patients in the randomised phase III RETRO study compared direct treatment costs over a one-year period in patients in RA in sustained remission who continued DMARD therapy, reduced their DMARD dosage by 50%, or tapered and then stopped DMARD therapy. Direct treatment costs included costs of conventional DMARDs, biological DMARDs and corticosteroids. The risk of relapse was lowest in patients with a low MBDA score (<30 units) who were ACPA-negative at baseline (19%), and highest in patients with an MBDA score >30 units who were ACPA-positive (61%). DMARD tapering appeared to be feasible in doublenegative patients (low MBDA score and ACPA-negative), and in patients who were single-positive for MBDA score (>30 units) or ACPA. Direct costs for full-dose DMARD therapy for one year in 41 double-negative or single-positive patients without an RA flare totalled €372 245. Tapering and stopping DMARD therapy in these patients with a low risk of relapse reduced DMARD costs by €219 712; the overall reduction in DMARD costs was €5358.83 per patient. Our study presents an approach toward costeffective stratified DMARD tapering. It addresses the current challenges in handling stable remission in patients with RA, the possibility of a biomarker-based stratified DMARD tapering approach, and the reduction in DMARD costs resulting from such a concept, said the investigators. Our present study shows that tapering or stopping DMARD achieves savings of direct healthcare costs, if the likelihood for relapse is low and the patients can permanently stay on a tapered DMARD regimen or could even stop treatment, they said.