AB0379 Tapering or Stopping of Methotrexate in Non-Tumor Necrosis Factor Therapy (Tocilizumab and Abatacept) in Patients with Rheumatoid Arthritis

BackgroundNon-tumor necrosis factor (TNF) agents, such as tocilizumab (TCZ) and abatacept (ABT), were widely used in the treatment of rheumatoid arthritis (RA). It seems that non-TNF agents are slightly different from anti-TNF agents in respect to dependency on methotrexate (MTX). Although MTX is a very important concomitant drug in anti-TNF therapy, MTX may not be so in non-TNF therapy for majority of patients. MTX have many severe adverse events (AE) such as interstitial pneumonia, severe infection, and myelosuppression. Tapering or stopping of MTX have been tried in our institute to avoid AE of MTX when RA patients treated with non-TNF agents reached at sustained remission. We report the preliminary results of MTX tapering in non-TNF therapy in this study.ObjectivesThis retrospective study evaluated tapering or stopping of MTX in non-TNF therapy (TCZ and ABT) and impact of it to RA treatment in clinical practice.Methods27 RA patients who initiated TCZ or ABT with concomitant MTX and continued non-TNF agents for 2 years were used. Time-course of disease activity (DAS28-CRP and CDAI), arthritis marker (serum MMP-3), activity of daily living (mHAQ), joint destruction (ΔmTSS per a year) and tapering concomitant drug (MTX and prednisolone) were investigated. MTX was tapered depending on physicians decisions and stopped if possible.Results20 females and 7 males with mean age of 60 years were used in this study. Mean RA duration was 11.8 years. TCZ was continued for 2 years in 16 cases and ABT in 11 cases. MTX of mean dosage of 9.0mg/week (4.0–16.0 mg/w) was prescribed in all patients at baseline. Mean DAS28-CRP was 4.57 at baseline, 2.26 at 1 year and 2.00 at 2 years. There were significant decreases not only from baseline to 1 years (p