Abstract
BackgroundThe aim of this study was to identify predictors of prolonged disease control after discontinuation of tumor necrosis factor inhibitor (TNFi) treatment in patients with rheumatoid arthritis (RA).MethodsPost-hoc analysis of 439 RA patients (67.3% rheumatoid factor positive) with longstanding RA in remission or with stable low disease activity, randomized to stopping TNFi treatment in the multicenter POET trial. Prolonged acceptable disease control was defined as not restarting TNFi treatment within 12 months after stopping. Baseline demographic and disease-related variables were included in univariate and multivariate logistic regression analysis for identifying predictors of relapse.ResultsOne year after baseline, 220 patients (50.1%) had not restarted TNFi treatment. Use of an anti-TNF monoclonal antibody (versus a receptor antagonist, OR = 2.41; 95% CI: 1.58–3.67), ≤10 yrs. disease duration (OR = 2.15; 95% CI: 1.42–3.26) and low or moderate multi-biomarker disease activity (MBDA) scores (OR = 2.00; 95% CI: 1.10–3.64) at baseline were independently predictive of successful TNFi discontinuation (area under the receiver operating characteristic curve = 0.66; 95% CI: 0.61–0.71). Results were similar when using no physician-reported flare as the criterion. TNFi-free survival was significantly different for patient groups based on the number of predictors present, ranging from 21.4% of patients with no predictor present to 66.7% of patients with all three predictors present.ConclusionPatients using an anti-TNF monoclonal antibody, with shorter disease duration and low or moderate baseline MBDA score are most likely to achieve prolonged disease control after TNFi discontinuation.Trial registrationNetherlands Trial Register NTR3112, 21 October 2011.
Highlights
The aim of this study was to identify predictors of prolonged disease control after discontinuation of tumor necrosis factor inhibitor (TNFi) treatment in patients with rheumatoid arthritis (RA)
As the current study aimed to identify patient and clinical characteristics predictive of prolonged disease control after discontinuation of TNFi treatment, only the data from 439 patients randomized to the stop group and for whom baseline serum samples were collected to measure the multi-biomarker disease activity (MBDA) score [29] were used
70% of patients who were on an anti-TNF monoclonal antibody, with a disease duration of < 10 years and a MBDA score ≤ 44 were able to successfully stop their TNFi, while 80% of patients on a TNFi receptor antagonist, with a disease duration of ≥10 years and a MBDA score > 44 restarted their TNFi within 12 months of stopping
Summary
The aim of this study was to identify predictors of prolonged disease control after discontinuation of tumor necrosis factor inhibitor (TNFi) treatment in patients with rheumatoid arthritis (RA). The use of conventional synthetic disease modifying anti-rheumatic drug (csDMARDs) in combination with the more expensive biological agents (bDMARDs such as tumor necrosis factor inhibitors (TNFi) has been shown to be effective in reducing disease activity, improving physical function, and slowing radiographic damage [4,5,6]. This, may lead to unnecessary treatment and resource use, as several studies have suggested that a substantial number of RA patients in sustained remission or LDA can taper or altogether stop their TNFi without experiencing a disease flare [7, 8]. Two studies have found a tendency for more relapses among female patients [13, 17]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
