Abstract
BackgroundInhibitors of tumor necrosis factor alpha (TNF-α) are current mainstay of therapies for rheumatoid arthritis (RA). The decision when to withdraw TNF-α inhibitors after achieving remission and the incidence of relapse rates with elective discontinuation are both important questions that demand intense survey in these patients. In this meta-analysis we aimed to estimate the magnitude of relapse rate after elective TNF-α inhibitor discontinuation in RA patients with remission.MethodsSystematic searches of PubMed/MEDLINE, Cochrane Library databases, grey literature (unpublished and ongoing trials) from the WHO International Clinical Trials Registry Platform and the US National Institutes of Health were performed for studies reporting the outcomes of elective discontinuation of TNF-α inhibitor in RA patients after remission. Random-effects models for meta-analyses were conducted on extracted data.ResultsOut of 390 references screened, 16 RCTs were included. Meta-analysis of 1264 patient data revealed a relapse rate of 0.47 (95% CI 0.41–0.54). Sensitivity analysis showed that none of the studies had higher influence on the results.ConclusionsAlmost half of all the RA patients in remission relapse after elective TNF-α inhibitor discontinuation. This information might be useful when considering this management option with individual patients.
Highlights
Inhibitors of tumor necrosis factor alpha (TNF-α) are current mainstay of therapies for rheumatoid arthritis (RA)
Criteria for Tumor necrosis factor alpha (TNF-α) inhibitor withdrawal were based on the DAS28/44 scoring system in 11 studies, clinical parameters in one study, and undefined in four studies
The results of our meta-analysis provide much needed information regarding the magnitude of the overall risk of relapse in RA patients receiving TNF-α inhibitor therapy, where treatment withdrawal is being considered by the patient and/or the treating physician
Summary
Inhibitors of tumor necrosis factor alpha (TNF-α) are current mainstay of therapies for rheumatoid arthritis (RA). The decision when to withdraw TNF-α inhibitors after achieving remission and the incidence of relapse rates with elective discontinuation are both important questions that demand intense survey in these patients. In this meta-analysis we aimed to estimate the magnitude of relapse rate after elective TNF-α inhibitor discontinuation in RA patients with remission. Rheumatoid arthritis (RA) is a chronic multisystem autoimmune inflammatory disease that leads to significant joint inflammation with damage and deformity. RA affects all populations, with few ethnic variations (e.g., 5– 6% in some Native American groups vs 0.8% in black-Caribbeans) [1, 2]. The DMARDs include non-biologic (e.g. methotrexate) and biologic agents (TNF-α inhibitor drugs and non TNF-α biologics) that halt the progression of RA by reducing inflammation, preventing joint damage and maintaining the integrity of joints [1]
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