Stepping Down Anti-TNF Appears Safe in RA After Remission

Gradually increasing the interval between doses of anti-TNF injections does not appear to increase the risk of relapse or progression among patients with established rheumatoid arthritis (RA) who have achieved remission. This result from a randomized trial, the Spacing of TNF-Blocker Injections in Rheumatoid Arthritis Study (STRASS), will be discussed Tuesday in a late-breaking session at the American College of Rheumatology meeting.

The 18-month trial from the University of Paris medical center randomized 137 patients with RA to continue their regular schedule of adalimumab or etanercept or to have an increase of 50% in the interval between treatments every three months, completely stopping the drugs after the fourth round of injections. (If remission was not maintained as assessed by the DAS28 scale, the dose spacing returned to pretrial intervals.)

Only 18% of the experimental group had to return to the previous treatment schedule. Two-thirds of the group successfully tapered treatments and 15% were able to stop entirely. Although there were more relapses in the step-down arm than among subjects who continued the usual treatment intervals, the Paris team concludes that there was no significant difference in disease activity as measured by DAS-28 or in functional status.

The team is now assessing the impact of the strategy on structural damage as assessed by X-rays.


Also from ACR2012:

ACR2012 Highlights: Rheumatoid Arthritis Comorbidities and Adverse Events ACR2012 Highlights: Rheumatoid Arthritis Diagnosis and Prognosis ACR2012 Highlights: Rheumatoid Arthritis Treatment “Magic Bullet” Approaching for Systemic JIA: But Which One? FDA Panel on Biosimilars: Analytics Should Trump Clinical Trials JAK Inhibitors Newer Than Tofacitinib (and Better?) Wait in the Wings