E020 Biologic withdrawal in seronegative arthritis: safe and cost-effective

Background/Aims Biologic therapies have transformed the management of rheumatoid arthritis (RA), but their long-term use carries significant financial implications for healthcare systems. Current NICE guidelines recommend considering tapering or discontinuing biologics in patients with stable disease. We conducted a retrospective audit to evaluate the safety, effectiveness, and financial impact of stopping biologics in patients with stable RA. Methods We performed a retrospective audit of 30 RA patients managed at North Tees University Hospital who had biologic therapy discontinued in line with NICE guidance. Data were extracted from electronic records and clinic letters using a standardised proforma and analysed in Excel. Demographic details, disease serology, duration on biologics, reason for withdrawal, subsequent outcomes, and recommencement rates were assessed. Cost savings were estimated using average biologic drug costs from the British National Formulary (BNF). Results Of the 30 patients audited, 66% were aged between 51-70 years and 90% were female. The majority (87%) were seronegative for rheumatoid factor and anti-CCP antibodies. The duration of biologic use prior to discontinuation varied: 24 patients (80%) had received treatment for 2-5 years, 4 patients (13%) for 6-10 years, and 1 patient (3%) for <2 years. The mean duration was 4.0 years, with a median of 3.5 years. Following withdrawal, 77% of patients remained in remission, with success rates notably higher in seronegative patients (92%). Only 7% required restarting of biologic therapy due to relapse. Approximately 50% of patients were subsequently discharged from rheumatology services, reflecting long-term stability. In two-thirds of cases, alternative causes were identified for musculoskeletal symptoms rather than inflammatory disease activity. The estimated cost savings from biologic discontinuation were substantial, with average annual expenditure of more than £16,500, based on BNF prices. This represents a significant opportunity for savings within the NHS without compromising patient outcomes. Conclusion Our audit demonstrates that discontinuation of biologic therapy in seronegative RA patients with stable disease is safe, effective, and aligned with NICE recommendations. The majority of patients remained in remission, with very low rates of relapse requiring re-initiation of biologics. We suggest that alternative causes of patients’ symptoms should be looked into if symptoms continue. Furthermore, the practice generated savings of more than £16,500 annually, averaging at £560 for our cohort of 30 patients.