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Decision making regarding treatment withdrawal or dose tapering
should be made carefully as withdrawal of anti-TNF treatment significantly
reduced the 5-year health care cost but also caused poor clinical outcomes in
RA patients.
Today, rheumatoid arthritis (RA) estimated 0.24% prevalence with considerable economic costs worldwide. Strategies like anti-TNF (tumour necrosis factor-α) maintenance, dose tapering or withdrawal exhibits unique role in managing RA with improved symptoms, cost-effectiveness as well as obstructing radiographic progression.
To evaluate health care costs and disease control, Aletaha D and colleagues conducted a 5-year real-world treatment which involves comparison of tumour necrosis factor-α inhibitors (anti-TNFs) adalimumab, etanercept or infliximab maintenance with dose tapering or withdrawal treatments. This estimation was done by using a -year Markov model with a 1-month cycle. The model determined the medical and anti-TNF costs and time (time to loss of disease control and to regaining control after the treatment). For analysis patients with RA who achieved remission ([DAS28] < 2.6) or had low disease activity (LDA; DAS28 < 3.2) were taken. Fourteen studies which included 2309 patients were meta-analyzed to estimate the risk of losing disease control which is adjusted for RA patient type, treatment strategy, anti-TNF and model entry criterion (remission or LDA).
According to analysis, the anti-TNF maintenance obtained comparable 5-year total costs (€67,100-€72,100), which was higher than anti-TNF withdrawal and tapering (€37,900-€59,700 vs €47,500-€59,200). The total costs were higher among established RA patients (€45,900-€72,100) as compared to early RA patients (€37,900-€71,700). The longest time to loss of disease control was noted in maintenance strategy (range, 27.3-47.1 months) whereas shortest in withdrawal strategy (range, 6.9-30.5 months).
Clinico Economics and Outcomes Research
Clinical and economic analysis of outcomes of dose tapering or withdrawal of tumor necrosis factor-a inhibitors upon achieving stable disease activity in rheumatoid arthritis patients
Aletaha D et al.
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