When RA is in remission, should TNFi therapy be discontinued?

Aug 19, 2016

This slideshow sums up the current literature on the practice of continuing or discontinuing therapies when rheumatoid arthritis is in remission or stable low disease activity.

ACR RecommendationsThe American College of Rheumatology 2015 rheumatoid arthritis treatment guidelines suggest that for patients with established RA who are in remission, or who have low disease activity, DMARD, TNFi, non-TNF biologic or tofacitinib therapy should be continued. These recommendations are based on clinical observations and experience that suggest that only a small minority of patients with low disease activity (not remission) are able to successfully discontinue all RA therapy. And, if all RA therapies are discontinued, flare risks are high.This slideshow sums up the current literature on the practice of continuing or discontinuing therapies when rheumatoid arthritis is in remission or stable low disease activity.

References:

Marjan Ghiti Moghadam, Harald E. Vonkeman, et al. “Stopping Tumor Necrosis Factor Inhibitor Treatment in Patients With Established Rheumatoid Arthritis in Remission or With Stable Low Disease Activity: A Pragmatic Multicenter, Open-Label Randomized Controlled Trial,”Arthritis and Rheumatology. July 27, 2016. DOI: 10.1002/art.39626

Jasvinder A. Singh, Kenneth Saag, et at.  “2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis,”Arthritis Care and Research. DOI 10.1002/acr.22783

Kavanaugh A, Lee SJ, Curtis JR, Greenberg JD, Kremer JM, Soto L, et al. Discontinuation of tumour necrosis factor inhibitors in patients with rheumatoid arthritis in low-disease activity: persistent benefits. Data from the Corrona registry. Ann Rheum Dis 2015;74:1150–5.

Harigai M, Takeuchi T, Tanaka Y, Matsubara T, Yamanaka H, Miyasaka N. Discontinuation of adalimumab treatment in rheumatoid arthritis patients after achieving low disease activity. Mod Rheumatol 2012;22:814–2.

Tanaka Y, Hirata S, Kubo S, Fukuyo S, Hanami K, Sawamukai N, et al. Discontinuation of adalimumab after achieving remission in patients with established rheumatoid arthritis: 1-year outcome of the HONOR study. Ann Rheum Dis 2015;74:389–95.

Roux CH, Brocq O, Breuil V, Albert C, Euller-Ziegler L. Safety of anti-TNF-α therapy in rheumatoid arthritis and spondylarthropathies with concurrent B or C chronic hepatitis. Rheumatology (Oxford) 2006;45:1294–7.

Van den Broek M, Klarenbeek NB, Dirven L, van Schaardenburg D, Hulsmans HM, Kerstens PJ, et al. Discontinuation of infliximab and potential predictors of persistent low disease activity in patients with early rheumatoid arthritis and disease activity score-steered therapy: subanalysis of the BeSt study. Ann Rheum Dis 2011;70:1389–94.

anaka Y, Takeuchi T, Mimori T, Saito K, Nawata M, Kameda H, et al. Discontinuation of infliximab after attaining low disease activity in patients with rheumatoid arthritis: RRR (remission induction by Remicade in RA) study. Ann Rheum Dis 2010;69:1286–91.

Smolen JS, Nash P, Durez P, Hall S, Ilivanova E, Irazoque-Palazuelos F, et al. Maintenance, reduction, or withdrawal of etanercept after treatment with etanercept and methotrexate in patients with moderate rheumatoid arthritis (PRESERVE): a randomised controlled trial. Lancet 2013;381:918–29.

Van Vollenhoven RF, Ostergaard M, Leirisalo-Repo M, Uhlig T, Jansson M, Larsson E, et al. Full dose, reduced dose or discontinuation of etanercept in rheumatoid arthritis. Ann Rheum Dis 2016;75:52–8.

Botsios C, Furlan A, Ostuni R, Sfriso R, Todesco S, Punzi L. Effects of low-dose etanercept in maintaining DAS-remission previously achieved with standard-dose in patients with rheumatoid arthritis. Ann Rheum Dis 2007;66:54–54.

Emery P, Hammoudeh M, FitzGerald O, Combe B, Martin Mola E, Bukowski J, et al. 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 study. Ann Rheum Dis 2014;72 Suppl 3:A399.

Van Herwaarden N, van der Maas A, Minten MJ, van den Hoogen FH, Kievit W, van Vollenhoven RF, et al. Disease activity guided dose reduction and withdrawal of adalimumab or etanercept compared with usual care in rheumatoid arthritis: open label, randomised controlled, non-inferiority trial. BMJ 2015;350:h1389.