Past Grantees and their Projects

Evidence Gap This Study Seeks to Address: Biologic disease-modifying anti-rheumatic drugs (bDMARDs), such as anti-tumor necrosis factor medications (anti-TNFs), improve outcomes in rheumatoid arthritis (RA). However, their use is associated with dose- and age-dependent adverse effects. Current guidelines recommend de-escalating (or deprescribing) bDMARDs in RA patients with low disease activity or in remission. Anti-TNFs are de-escalated in 21% of Medicare beneficiaries with RA in usual care. It remains unclear how often and which sub-group of older adults sustain de-escalation, and whether this is associated with increases in potentially problematic substitutes, such as glucocorticoids (GCs) and opioids.

Primary Study Aims:

Aim 1: To evaluate the frequency of, and factors associated with, sustained anti-TNF de-escalation among older adults with RA.

Aim 2: To assess whether sustained de-escalation is associated with compensatory increases in the use of GCs and opioids.

Study Design: This study will use 20% Medicare claims data from 2007–2021 to identify adults aged ≥66 years with RA who were on anti-TNF therapy for at least 6–7 months (a proxy for stable disease). Sustained (12 months) de-escalation, including dose reduction and dosing interval increase, will be analyzed. Multivariable analyses will explore factors associated with sustained de-escalation. Long-term GC and opioid use will be compared between older adults with sustained de-escalation and those with escalation or resumption of bDMARD therapy. Members of the Turner Geriatric Patient and Family Advisory Committee will provide feedback on the study, review results, and help interpret findings.