Grant: Project Grant

Rheumatoid arthritis is a chronic autoimmune disease that affects up to 1% of the adult population and causes fatigue, joint pain, swelling and a reduced quality of life. Fortunately, the treatment for rheumatoid arthritis has advanced, and most patients can now have their disease effectively controlled with medications. After a patient's disease has been successfully treated and controlled, the usual practice is to continue with these medications for life. Emerging evidence suggests some patients may be able to successfully reduce medication once their disease is under control, but this evidence has important limitations, and more clinical trials are needed. In this grant, we will conduct a clinical trial to evaluate the effectiveness and safety of a patient-centered approach for treatment reduction in patients with rheumatoid arthritis. The study will be embedded within an ongoing national study of over 2000 patients with rheumatoid arthritis. From this study, we will identify patients whose disease has been well controlled for at least 6 months and ask if they would like to participate. Interested patients will be randomized to either usual care or a structured but flexible approach to reduce treatment in a shared decision with their physician. Treatment outcomes, including both benefits (ability to successfully reduce treatment) and harms (disease flares) will be compared over 18 months. Alongside these outcomes, we will also measure patient preferences for the benefits and harms, and other outcomes to evaluate the impact on healthcare costs. The data generated will provide real-world data on a patient-centered approach to treatment reduction in patients with rheumatoid arthritis, a common chronic disease with high drug costs.