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Research Article
30 July 2026

Effect of dose tapering policy on the prescription of advanced therapy for rheumatoid arthritis: a retrospective analysis of clinical and cost outcomes in Taiwan

Authors: Ko-Jen Li https://orcid.org/0000-0002-4544-4620, Chao-Hsiun Tang https://orcid.org/0000-0003-0545-1567, Chia-Li Chang https://orcid.org/0009-0009-5418-1840, Han-Fang Liao https://orcid.org/0009-0006-6616-6021, Pei-Jung Yen, and Wen-Yi Shau https://orcid.org/0000-0003-3977-1729 [email protected]Author Info & Affiliations
Volume 15, Number 8
https://doi.org/10.57264/cer-2026-0020
PDFFormats

Abstract

Aim: To evaluate the impact of the Taiwan National Health Insurance program policy for advanced rheumatoid arthritis (aRA) therapies on treatment prescription patterns and costs in patients with rheumatoid arthritis (RA). Materials & methods: We performed a retrospective analysis of patients with RA aged ≥18 years who had commenced aRA treatment in the National Health Insurance research database in Taiwan between 2011 and 2017. Follow-up data were aggregated every 3 months to determine the proportion of the covered RA prescription days and the medical cost. Associations of the tapering policy initiation in 2014, aRA dose, non-aRA prescription and cost were analyzed using a generalized linear model. Results: In total, 9099 patients with RA were included in this study. Before the policy implementation, the probability of aRA dose tapering increased significantly once treatment duration reached 24 months, with adjusted odds ratio = 3.27 (p < 0.001); this further increased to 4.00 (p < 0.001) after the policy was implemented. The difference between both adjusted odds ratios was statistically significant (p = 0.012). Dose tapering for aRA was associated with reduced medical costs and decreased use of other RA prescription drugs. However, the number of reductions decreased after the dose tapering policy was initiated, suggesting an unintended effect of the policy. Conclusion: The policy implementation increased the dose tapering of aRA prescriptions and was associated with decreased medication costs and the use of other RA treatments. However, a moderate partial offset of the reduction in outcome measures suggests unintended consequences of the policy.

Plain language summary

What is this article about?

This study examined how a National Health Insurance policy in Taiwan changed the way doctors prescribe advanced medicines for rheumatoid arthritis. The policy requires doctors to reduce the dose of advanced rheumatoid arthritis drugs after 2 years of treatment if the disease remains stable.

What did the researchers do?

We analyzed real-world data from 9099 adults with RA who started advanced therapy between 2011 and 2017. We compared prescription patterns and costs before and after the policy was introduced.

What were the results?

After the policy was initiated, dose tapering became more common, especially for patients treated for more than 2 years. Dose tapering was associated with lower medication costs and reduced use of other RA drugs. However, some unintended effects were observed, such as smaller cost savings and slight increases in steroid use in certain patients.

Why is this important?

These findings show that mandatory dose reduction can lower costs and reduce drug exposure, but it may also lead to trade-offs in disease control. Policymakers and doctors should consider these effects when designing treatment guidelines and reimbursement policies.

Shareable abstract

In a comprehensive review, we found that the advanced-therapy tapering policy continues to be effective for patients with rheumatoid arthritis in a real-world setting in Taiwan.

Supplementary Material

File (supplementary material.docx)

References

Papers of special note have been highlighted as: • of interest; •• of considerable interest
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