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Letter
Three-year cost-effectiveness analysis of the DRESS study: protocolised tapering is key
  1. Nathan den Broeder1,
  2. Chantal A M Bouman1,
  3. Wietske Kievit2,
  4. Noortje van Herwaarden1,
  5. Frank H J van den Hoogen1,3,
  6. Ronald F van Vollenhoven4,5,
  7. Hans W J Bijlsma6,
  8. Aatke van der Maas1,
  9. Alfons A den Broeder1,3
  1. 1 Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands
  2. 2 Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
  3. 3 Department of Rheumatology, Radboud University Medical Centre, Nijmegen, The Netherlands
  4. 4 Department of Clinical Immunology and Rheumatology, Academic Medical Center, Amsterdam, The Netherlands
  5. 5 Department of Rheumatology, VU University Medical Centre, Amsterdam, The Netherlands
  6. 6 Department of Rheumatology & Clinical Immunology, Utrecht University Medical Centre, Utrecht, The Netherlands
  1. Correspondence to Dr Alfons A den Broeder, Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands; a.denbroeder{at}maartenskliniek.nl

https://doi.org/10.1136/annrheumdis-2018-213547

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    The DRESS (Dose REduction Strategy of Subcutaneous TNF inhibitors) study previously showed clinical non-inferiority and superior cost-effectiveness of disease activity-guided tapering of tumour necrosis factor inhibitors (TNFi) (dose reduction, DR group) over full dose continuation (usual care, UC group) in patients with rheumatoid arthritis (RA) with low disease activity.1 2 The safety and efficacy of this strategy were maintained up to 3 years, with a large reduction in TNFi use.3 During the extension phase, the majority of the UC group attempted dose reduction. This prevented a valid comparison of disease activity-guided tapering with full dose continuation over the entire study period but presented an opportunity to make the following comparisons:

    1. Tapering long-term results (in the DR group 18–36 months) versus short-term results (in the DR group 0–18 months).

    2. Tapering at the rheumatologist’s discretion (in the UC group 18–36 months) compared with full dose continuation (in the UC group 0–18 months). …

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    Footnotes

    • Handling editor Josef S Smolen

    • Contributors NvH, AAdB, AvdM, WK, FHJvdH, RFvV, NdB and HWJB were involved in the study design. NvH, AAdB, AvdM and FHJvdH were involved in the data collection. NdB and WK performed the data analyses. All authors were involved in writing, revision and final approval of the manuscript. NdB is the study guarantor.

    • Competing interests RFvV: grants from AbbVie, Amgen, BMS, GSK, Pfizer, Roche and UCB, and personal fees from AbbVie, Biotest, BMS, Celgene, Crescendo, GSK, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, UCB and Vertex, outside the submitted work. HWJB: grants and personal fees from Pfizer and AbbVie, during the conduct of the study, and grants and personal fees from Roche, Bristol-Myers Squibb and Union Chimique Belge, outside the submitted work. AAdB: Congress invitations from Roche and AbbVie and an expert witness fee from Amgen.

    • Patient consent Not required.

    • Ethics approval CMO Regio Arnhem-Nijmegen: NL37704.091.11.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement The authors commit to making the relevant anonymised patient-level data available on reasonable request.