Stopping tumour necrosis factor-targeted biological DMARDs in rheumatoid arthritis
- 17 November 2016
- journal article
- review article
- Published by Oxford University Press (OUP) in Rheumatology
- Vol. 55 (suppl 2), ii15-ii22
- https://doi.org/10.1093/rheumatology/kew352
Abstract
The combined use of MTX and biological DMARDs (bDMARDs) targeting TNF has revolutionized treatment of RA, and clinical remission becomes a realistic treatment goal. After sustained remission, discontinuation of bDMARDs without disease flare has been emerging as an important theme from the risk-benefit point of view and economic burden. According to several studies, approximately half of early RA patients could discontinue TNF-targeted bDMARDs without clinical flare and functional impairment after obtaining low disease activity or remission by treatment with bDMARDs and MTX. For established RA, however, fewer patients sustained remission or low disease activity after the discontinuation of bDMARDs, compared with early RA. The results were controversial among studies, and the percentage of patients who could successfully discontinue bDMARDs ranged from 13 to 48% at 1 year after discontinuation. From the adalimumab discontinuation without functional and radiographic damage progression following sustained remission study and the induction of remission by infliximab in RA study, deep remission at discontinuation was a key factor for maintaining the treatment holiday of bDMARDs in established RA patients. However, such early intensive treatment would have the potential for reducing drug-induced adverse effects and reducing long-term medical costs, although the risks of worsening clinical, structural and functional outcomes should be considered, with careful monitoring.Keywords
This publication has 21 references indexed in Scilit:
- A randomised controlled trial of etanercept and methotrexate to induce remission in early inflammatory arthritis: the EMPIRE trialAnnals Of The Rheumatic Diseases, 2014
- Is It Possible to Withdraw Biologics From Therapy in Rheumatoid Arthritis?Clinical Therapeutics, 2013
- Adjustment of therapy in rheumatoid arthritis on the basis of achievement of stable low disease activity with adalimumab plus methotrexate or methotrexate alone: the randomised controlled OPTIMA trialThe Lancet, 2013
- Remission induction comparing infliximab and high-dose intravenous steroid, followed by treat-to-target: a double-blind, randomised, controlled trial in new-onset, treatment-naive, rheumatoid arthritis (the IDEA study)Annals Of The Rheumatic Diseases, 2013
- FRI0089 Assessing maintenance of remission with reduced dose etanercept plus methotrexate, methotrexate alone, or placebo in patients with early rheumatoid arthritis who achieved remission with etanercept and methotrextate: the prize studyAnnals Of The Rheumatic Diseases, 2013
- Next stage of RA treatment: is TNF inhibitor-free remission a possible treatment goal?Annals Of The Rheumatic Diseases, 2012
- Induction therapy with adalimumab plus methotrexate for 24 weeks followed by methotrexate monotherapy up to week 48 versus methotrexate therapy alone for DMARD-naïve patients with early rheumatoid arthritis: HIT HARD, an investigator-initiated studyAnnals Of The Rheumatic Diseases, 2012
- Discontinuing treatment in patients with rheumatoid arthritis in sustained clinical remission: exploratory analyses from the BeSt studyAnnals Of The Rheumatic Diseases, 2010
- Benefits 8 years after a remission induction regime with an infliximab and methotrexate combination in early rheumatoid arthritisRheumatology, 2010
- Very early treatment with infliximab in addition to methotrexate in early, poor‐prognosis rheumatoid arthritis reduces magnetic resonance imaging evidence of synovitis and damage, with sustained benefit after infliximab withdrawal: Results from a twelve‐month randomized, double‐blind, placebo‐controlled trialArthritis & Rheumatism, 2005