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Health-related quality of life outcomes in patients with rheumatoid arthritis and ankylosing spondylitis after tapering biologic treatment

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Abstract

Treatment with biological disease-modifying anti-rheumatic drugs (bDMARDs) for rheumatoid arthritis (RA) and ankylosing spondylitis (AS) is popular. The aim of this study was to investigate changes in the quality of life (QoL) in patients after receiving, tapering, or stopping bDMARD treatment. Three hundred and thirty patients with RA and 120 patients with AS were enrolled. Data on the patients receiving bDMARDs were obtained by self-completed questionnaires including the short-form 36 (SF-36) and Global Quality of Life (GQL) scale. A relapse was defined as the QoL becoming worse than that before bDMARD treatment. Significant improvement in all domains of the SF-36 and GQL was noted in the patients after receiving bDMARDs. Improvement in SF-36 was significantly greater in RA patients with a shorter disease duration (< 6 years) and milder patient-assessed disease activity and in AS patients with a shorter disease duration and younger age. There were significant decreases in all domains of the SF-36 and GQL in both groups after reducing/discontinuing bDMARD treatment. The patients in both groups with a shorter period of bDMARD treatment (≤ 3 years) had significantly worse SF-36 scores compared to those with a longer period of bDMARD treatment (> 3 years). The relapse rate after reducing/discontinuing treatment was over 90.0% in the RA patients and over 50.0% in the AS patients within 12 months. bDMARDs significantly improved the QoL of the patients with RA and AS. However, interrupting or stopping the treatment protocol worsened the QoL and led to relapses, especially in the patients who used bDMARDs for a shorter period.

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References

  1. Graudal N (2004) The natural history and prognosis of rheumatoid arthritis: association of radiographic outcome with process variables, joint motion and immune proteins. Scand J Rheumatol Suppl 118:1–38

    Article  PubMed  Google Scholar 

  2. Whalley D, McKenna SP, de Jong Z, van der Heijde D (1997) Quality of life in rheumatoid arthritis. Br J Rheumatol 36(8):884–888. https://doi.org/10.1093/rheumatology/36.8.884

    Article  CAS  PubMed  Google Scholar 

  3. Koh ET, Leong KP, Tsou IY, Lim VH, Pong LY, Chong SY, Seow A, Tan Tock Seng Hospital Rheumatoid Arthritis (TTSH RA) Study Group (2006) The reliability, validity and sensitivity to change of the Chinese version of SF-36 in oriental patients with rheumatoid arthritis. Rheumatology (Oxford) 45(8):1023–1028. https://doi.org/10.1093/rheumatology/kel051

    Article  CAS  Google Scholar 

  4. Staples MP, March L, Lassere M, Reid C, Buchbinder R (2011) Health-related quality of life and continuation rate on first-line anti-tumour necrosis factor therapy among rheumatoid arthritis patients from the Australian Rheumatology Association Database. Rheumatology (Oxford) 50(1):166–175. https://doi.org/10.1093/rheumatology/keq322

    Article  CAS  Google Scholar 

  5. Heidari B (2011) Rheumatoid arthritis: early diagnosis and treatment outcomes. Caspian J Intern Med 2(1):161–170

    PubMed  PubMed Central  Google Scholar 

  6. Khan MA, van der Linden SM (1990) Ankylosing spondylitis and other spondyloarthropathies. Rheum Dis Clin N Am 16:551–579

    CAS  Google Scholar 

  7. Zochling J, Brandt J, Braun J (2005) The current concept of spondyloarthritis with special emphasis on undifferentiated spondyloarthritis. Rheumatology (Oxford) 44(12):1483–1491. https://doi.org/10.1093/rheumatology/kei047

    Article  CAS  Google Scholar 

  8. Ward MM (1998) Quality of life in patients with ankylosing spondylitis. Rheum Dis Clin N Am 24(4):815–827. https://doi.org/10.1016/S0889-857X(05)70043-0

    Article  CAS  Google Scholar 

  9. Ward MM (1999) Health-related quality of life in ankylosing spondylitis: a survey of 175 patients. Arthritis Care Res 12(4):247–255. https://doi.org/10.1002/1529-0131(199908)12:4<247::AID-ART3>3.0.CO;2-H

    Article  CAS  PubMed  Google Scholar 

  10. Yang X, Fan D, Xia Q, Wang M, Zhang X, Li X, Cai G, Wang L, Xin L, Xu S, Pan F (2016) The health-related quality of life of ankylosing spondylitis patients assessed by SF-36: a systematic review and meta-analysis. Qual Life Res 25(11):2711–2723. https://doi.org/10.1007/s11136-016-1345-z

    Article  PubMed  Google Scholar 

  11. Barkham N, Kong KO, Tennant A, Fraser A, Hensor E, Keenan AM, Emery P (2005) The unmet need for anti-tumour necrosis factor (anti-TNF) therapy in ankylosing spondylitis. Rheumatology (Oxford) 44(10):1277–1281. https://doi.org/10.1093/rheumatology/keh713

    Article  CAS  Google Scholar 

  12. Bae SC, Gun SC, Mok CC, Khandker R, Nab HW, Koenig AS, Vlahos B, Pedersen R, Singh A (2013) Improved health outcomes with etanercept versus usual DMARD therapy in an Asian population with established rheumatoid arthritis. BMC Musculoskelet Disord 14(1):13. https://doi.org/10.1186/1471-2474-14-13

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Curtis JR, Singh JA (2011) Use of biologics in rheumatoid arthritis: current and emerging paradigms of care. Clin Ther 33(6):679–707. https://doi.org/10.1016/j.clinthera.2011.05.044

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Gossec L, Berenbaum F, Chauvin P, Lamiraud K, Russo-Marie F, Joubert JM, Saraux A (2014) Reporting of patient-perceived impact of rheumatoid arthritis and axial spondyloarthritis over 10 years: a systematic literature review. Rheumatology (Oxford) 53(7):1274–1281. https://doi.org/10.1093/rheumatology/ket480

    Article  Google Scholar 

  15. Kekow J, Moots RJ, Emery P, Durez P, Koenig A, Singh A, Pedersen R, Robertson D, Freundlich B, Sato R (2010) Patient-reported outcomes improve with etanercept plus methotrexate in active early rheumatoid arthritis and the improvement is strongly associated with remission: the COMET trial. Ann Rheum Dis 69(01):222–225. https://doi.org/10.1136/ard.2008.102509

    Article  CAS  PubMed  Google Scholar 

  16. Gartlehner G, Hansen RA, Jonas BL, Thieda P, Lohr KN (2006) The comparative efficacy and safety of biologics for the treatment of rheumatoid arthritis: a systematic review and metaanalysis. J Rheumatol 33(12):2398–2408

    CAS  PubMed  Google Scholar 

  17. Singh JA, Cameron C, Noorbaloochi S, Cullis T, Tucker M, Christensen R, Ghogomu ET, Coyle D, Clifford T, Tugwell P, Wells GA (2015) Risk of serious infection in biological treatment of patients with rheumatoid arthritis: a systematic review and meta-analysis. Lancet 386(9990):258–265. https://doi.org/10.1016/S0140-6736(14)61704-9

    Article  PubMed  PubMed Central  Google Scholar 

  18. Tanaka Y, Hirata S, Saleem B, Emery P (2013) Discontinuation of biologics in patients with rheumatoid arthritis. Clin Exp Rheumatol 31(4 Suppl 78):S22–S27

    PubMed  Google Scholar 

  19. Smolen JS, Breedveld FC, Burmester GR, Bykerk V, Dougados M, Emery P, Kvien TK, Navarro-Compán MV, Oliver S, Schoels M, Scholte-Voshaar M, Stamm T, Stoffer M, Takeuchi T, Aletaha D, Andreu JL, Aringer M, Bergman M, Betteridge N, Bijlsma H, Burkhardt H, Cardiel M, Combe B, Durez P, Fonseca JE, Gibofsky A, Gomez-Reino JJ, Graninger W, Hannonen P, Haraoui B, Kouloumas M, Landewe R, Martin-Mola E, Nash P, Ostergaard M, Östör A, Richards P, Sokka-Isler T, Thorne C, Tzioufas AG, van Vollenhoven R, de Wit M, van der Heijde D (2016) Treating rheumatoid arthritis to target: 2014 update of the recommendations of an international task force. Ann Rheum Dis 75(1):3–15. https://doi.org/10.1136/annrheumdis-2015-207524

    Article  PubMed  Google Scholar 

  20. Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS et al (1988) The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 31(3):315–324. https://doi.org/10.1002/art.1780310302

    Article  CAS  PubMed  Google Scholar 

  21. Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO 3rd, Bingham CO III, Birnbaum NS, Burmester GR, Bykerk VP, Cohen MD, Combe B, Costenbader KH, Dougados M, Emery P, Ferraccioli G, Hazes JMW, Hobbs K, Huizinga TWJ, Kavanaugh A, Kay J, Kvien TK, Laing T, Mease P, Ménard HA, Moreland LW, Naden RL, Pincus T, Smolen JS, Stanislawska-Biernat E, Symmons D, Tak PP, Upchurch KS, Vencovský J, Wolfe F, Hawker G (2010) 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum 62(9):2569–2581. https://doi.org/10.1002/art.27584

    Article  PubMed  Google Scholar 

  22. van der Linden S, Valkenburg HA, Cats A (1984) Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum 27(4):361–368. https://doi.org/10.1002/art.1780270401

    Article  PubMed  Google Scholar 

  23. van Gestel AM, Prevoo ML, van ’t Hof MA, van Rijswijk MH, van de Putte LB, van Riel PL (1996) Development and validation of the European League Against Rheumatism response criteria for rheumatoid arthritis. Comparison with the preliminary American College of Rheumatology and the World Health Organization/International League Against Rheumatism Criteria. Arthritis Rheum 39:34–40

    Article  PubMed  Google Scholar 

  24. Garrett S, Jenkinson T, Kennedy LG, Whitelock H, Gaisford P, Calin A (1994) A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol 21:2286–2291

    CAS  PubMed  Google Scholar 

  25. Brazier J, Jones N, Kind P (1993) Testing the validity of the Euroqol and comparing it with the SF-36 health survey questionnaire. Qual Life Res 2(3):169–180. https://doi.org/10.1007/BF00435221

    Article  CAS  PubMed  Google Scholar 

  26. McHorney CA, Ware JE Jr, JF L, Sherbourne CD (1994) The MOS 36-item Short-Form Health Survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Med Care 32(1):40–66. https://doi.org/10.1097/00005650-199401000-00004

    Article  CAS  PubMed  Google Scholar 

  27. McHorney CA, Ware JE Jr, Raczek AE (1993) The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care 31(3):247–263. https://doi.org/10.1097/00005650-199303000-00006

    Article  CAS  PubMed  Google Scholar 

  28. Ware JE Jr, Kosinski M, Bayliss MS, McHorney CA, Rogers WH, Raczek A (1995) Comparison of methods for the scoring and statistical analysis of SF-36 health profile and summary measures: summary of results from the Medical Outcomes Study. Med Care 33(4 Suppl):AS264–AS279

    PubMed  Google Scholar 

  29. Lubeck DP (2004) Patient-reported outcomes and their role in the assessment of rheumatoid arthritis. PharmacoEconomics 22(S1):27–38. https://doi.org/10.2165/00019053-200422001-00004

    Article  PubMed  Google Scholar 

  30. Strand V, Singh JA (2008) Improved health-related quality of life with effective disease-modifying antirheumatic drugs: evidence from randomized controlled trials. Am J Manag Care 14(4):234–254

    PubMed  Google Scholar 

  31. Ivarsson B, Malm U, Lindstrom L, Norlander T (2010) The self-assessment Global Quality of Life scale: reliability and construct validity. Int J Psychiatry Clin Pract 14(4):287–297. https://doi.org/10.3109/13651501.2010.487217

    Article  PubMed  Google Scholar 

  32. Olsson M, Carlstrom E, Marklund B, Helldin L, Hjarthag F (2015) Assessment of distress and quality of life: a comparison of self-assessments by outpatients with a schizopsychotic illness and the clinical judgment of nurses. Arch Psychiatr Nurs 29(5):284–289. https://doi.org/10.1016/j.apnu.2015.05.001

    Article  PubMed  Google Scholar 

  33. Westhovens R, Cole JC, Li T, Martin M, Maclean R, Lin P et al (2006) Improved health-related quality of life for rheumatoid arthritis patients treated with abatacept who have inadequate response to anti-TNF therapy in a double-blind, placebo-controlled, multicentre randomized clinical trial. Rheumatology (Oxford) 45(10):1238–1246. https://doi.org/10.1093/rheumatology/kel066

    Article  CAS  Google Scholar 

  34. Keystone E, Burmester GR, Furie R, Loveless JE, Emery P, Kremer J, Tak PP, Broder MS, Yu E, Cravets M, Magrini F, Jost F (2008) Improvement in patient-reported outcomes in a rituximab trial in patients with severe rheumatoid arthritis refractory to anti-tumor necrosis factor therapy. Arthritis Rheum 59(6):785–793. https://doi.org/10.1002/art.23715

    Article  CAS  PubMed  Google Scholar 

  35. Strand V, Burmester GR, Ogale S, Devenport J, John A, Emery P (2012) Improvements in health-related quality of life after treatment with tocilizumab in patients with rheumatoid arthritis refractory to tumour necrosis factor inhibitors: results from the 24-week randomized controlled RADIATE study. Rheumatology (Oxford) 51(10):1860–1869. https://doi.org/10.1093/rheumatology/kes131

    Article  CAS  Google Scholar 

  36. Braun J, McHugh N, Singh A, Wajdula JS, Sato R (2007) Improvement in patient-reported outcomes for patients with ankylosing spondylitis treated with etanercept 50 mg once-weekly and 25 mg twice-weekly. Rheumatology (Oxford) 46(6):999–1004. https://doi.org/10.1093/rheumatology/kem069

    Article  CAS  Google Scholar 

  37. van der Heijde DM, Revicki DA, Gooch KL, Wong RL, Kupper H, Harnam N, Thompson C, Sieper J, the ATLAS Study Group (2009) Physical function, disease activity, and health-related quality-of-life outcomes after 3 years of adalimumab treatment in patients with ankylosing spondylitis. Arthritis Res Ther 11(4):R124. https://doi.org/10.1186/ar2790

    Article  PubMed  PubMed Central  Google Scholar 

  38. van der Heijde D, Deodhar A, Braun J, Mack M, Hsu B, Gathany TA, Inman RD, Han C, The GO-RAISE investigators (2014) The effect of golimumab therapy on disease activity and health-related quality of life in patients with ankylosing spondylitis: 2-year results of the GO-RAISE trial. J Rheumatol 41(6):1095–1103. https://doi.org/10.3899/jrheum.131003

    Article  PubMed  Google Scholar 

  39. van Herwaarden N, van der Maas A, Minten MJ, van den Hoogen FH, Kievit W, van Vollenhoven RF et al (2015) Disease activity guided dose reduction and withdrawal of adalimumab or etanercept compared with usual care in rheumatoid arthritis: open label, randomised controlled, non-inferiority trial. BMJ 350(apr09 23):h1389. https://doi.org/10.1136/bmj.h1389

    Article  PubMed  PubMed Central  Google Scholar 

  40. Brocq O, Millasseau E, Albert C, Grisot C, Flory P, Roux CH, Euller-Ziegler L (2009) Effect of discontinuing TNFalpha antagonist therapy in patients with remission of rheumatoid arthritis. Joint Bone Spine 76(4):350–355. https://doi.org/10.1016/j.jbspin.2008.11.009

    Article  CAS  PubMed  Google Scholar 

  41. Tanaka Y, Hirata S, Kubo S, Fukuyo S, Hanami K, Sawamukai N, Nakano K, Nakayamada S, Yamaoka K, Sawamura F, Saito K (2015) Discontinuation of adalimumab after achieving remission in patients with established rheumatoid arthritis: 1-year outcome of the HONOR study. Ann Rheum Dis 74(2):389–395. https://doi.org/10.1136/annrheumdis-2013-204016

    Article  CAS  PubMed  Google Scholar 

  42. Harigai M, Takeuchi T, Tanaka Y, Matsubara T, Yamanaka H, Miyasaka N (2012) Discontinuation of adalimumab treatment in rheumatoid arthritis patients after achieving low disease activity. Mod Rheumatol 22(6):814–822. https://doi.org/10.3109/s10165-011-0586-5

    Article  PubMed  Google Scholar 

  43. Emery P, Hammoudeh M, FitzGerald O, Combe B, Martin-Mola E, Buch MH, Krogulec M, Williams T, Gaylord S, Pedersen R, Bukowski J, Vlahos B (2014) Sustained remission with etanercept tapering in early rheumatoid arthritis. N Engl J Med 371(19):1781–1792. https://doi.org/10.1056/NEJMoa1316133

    Article  CAS  PubMed  Google Scholar 

  44. Nishimoto N, Amano K, Hirabayashi Y, Horiuchi T, Ishii T, Iwahashi M, Iwamoto M, Kohsaka H, Kondo M, Matsubara T, Mimura T, Miyahara H, Ohta S, Saeki Y, Saito K, Sano H, Takasugi K, Takeuchi T, Tohma S, Tsuru T, Ueki Y, Yamana J, Hashimoto J, Matsutani T, Murakami M, Takagi N (2014) Drug free REmission/low disease activity after cessation of tocilizumab (Actemra) Monotherapy (DREAM) study. Mod Rheumatol 24(1):17–25. https://doi.org/10.3109/14397595.2013.854079

    Article  CAS  PubMed  Google Scholar 

  45. Aguilar-Lozano L, Castillo-Ortiz JD, Vargas-Serafin C, Morales-Torres J, Sanchez-Ortiz A, Sandoval-Castro C, Padilla-Ibarra J, Hernandez-Cuevas C, Ramos-Remus C (2013) Sustained clinical remission and rate of relapse after tocilizumab withdrawal in patients with rheumatoid arthritis. J Rheumatol 40(7):1069–1073. https://doi.org/10.3899/jrheum.121427

    Article  CAS  PubMed  Google Scholar 

  46. Kavanaugh A, Lee SJ, Curtis JR, Greenberg JD, Kremer JM, Soto L, Etzel CJ, Cox V, Yoshida K, Reed GW, Solomon DH (2015) Discontinuation of tumour necrosis factor inhibitors in patients with rheumatoid arthritis in low-disease activity: persistent benefits. Data from the Corrona registry. Ann Rheum Dis 74(6):1150–1155. https://doi.org/10.1136/annrheumdis-2014-206435

    Article  CAS  PubMed  Google Scholar 

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Funding

This work was supported by the National Science Council (MOST 105-2314-B-075-043).

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Authors and Affiliations

  1. Division of Allergy, Immunology & Rheumatology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, 11217, Taiwan

    Ming-Han Chen, Hsien-Tzung Liao, Wei-Sheng Chen, Chien-Chih Lai & Chang-Youh Tsai

  2. Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan

    Ming-Han Chen, Hsien-Tzung Liao, Wei-Sheng Chen, Chien-Chih Lai & Chang-Youh Tsai

  3. Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan

    Mei-Hsuan Lee

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  1. Ming-Han Chen
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Chen, MH., Lee, MH., Liao, HT. et al. Health-related quality of life outcomes in patients with rheumatoid arthritis and ankylosing spondylitis after tapering biologic treatment. Clin Rheumatol 37, 429–438 (2018). https://doi.org/10.1007/s10067-017-3965-2

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