A new study by Canadian researchers will explore the possibility of reducing medication for arthritis patients whose disease has already been under control for a certain period of time.
Arthritis patients usually stay on medication for life, but there has been some evidence that a reduction in medication, a process known as drug tapering, may be feasible for some of these individuals. However, more research is required to weigh the benefits and risks of this approach for each patient.
To that end, Glen Hazlewood, MD, PhD, a rheumatologist and member of the Cumming School of Medicine’s McCaig Institute for Bone and Joint Health, and Vivian Bykerk, MD, from the University of Toronto have received funding from The Canadian Institutes of Health Research to study the safety and effectiveness of a patient-focused approach to reduce treatment in arthritis patients. Their trial will enroll patients who are part of a larger Canadian study called CATCH, or Canadian Early Arthritis Cohort.
“When a patient has been doing really well with their treatment, they often ask their rheumatologist, ‘When can I stop or reduce my medication?’ ” Hazlewood said in a press release. “It’s very rare that people can stop treatment completely, but we think that many may be able to successfully reduce their medications.”
A total of 200 patients whose disease has been controlled for at least six months will be randomized to either continue with their current medication or start a structured reduction of the treatment, in a shared decision with their physician.
The team will follow the patients for 18 months, after which the benefits and harms of the reduced treatment will be assessed. Patient perceptions on the reduced treatment will also be analyzed.
“No two patients are the same; they have different experiences with their disease,” Hazlewood said. “Some may not want to reduce their medications because they don’t want to risk a flare-up. For other patients, the benefits may outweigh the risks.”
The truth behind this statement is proven by two patients, Laurie Proulx and Dawn Richards, both members of the Canadian Arthritis Patient Alliance, a patient-driven organization that supports people with arthritis. Hazlewood sought the advice of the women, each with very different opinions on drug tapering, before designing the trial.
Proulx, who was diagnosed with juvenile idiopathic arthritis at 14 years old, fought for seven years to control her disease, making her reluctant to reduce her medication.
“Because it took so long to get my disease under control, and because I have life-threatening complication of the disease (airway issues), I would say that I would not consider it or proceed with extreme caution,” Proulx said.
On the other hand, Richards, who was diagnosed with rheumatoid arthritis 12 years ago, considered reducing medication as soon as she became clinically stable and her disease reached a state of remission. Together with her rheumatologist, Richards decided to taper her drug regimen.
“As a person who has lived with rheumatoid arthritis for over a decade, I can tell you that the one thing a patient wishes for on a daily basis is simply to no longer be a patient,” Richards said.
“I now have one to two days per week that I call my RA [rheumatoid arthritis] ‘drug holidays.’ These are days that are blissfully medication free. It’s as close to not having arthritis as I will ever be,” she said.
With this guidance in mind, the goal of the study is to strike a balance between measuring the effectiveness of drug tapering and taking into account each individual’s experience.
“We first want to make sure that reducing medication is safe and effective,” Hazlewood said. “But beyond this, we want to understand patient preferences for the risk and benefit trade-offs. Hopefully, this will help provide guidance in terms of how rheumatologists can best advise their patients to choose the treatment that’s best for them.”