RESEARCH - Discontinuation of Remicade in RA patients in clinical remission

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Mod Rheumatol. 2008 Jun 6.

Discontinuation of infliximab in rheumatoid arthritis patients in

clinical remission.

Nawata M, Saito K, Nakayamada S, Tanaka Y.

The First Department of Internal Medicine, School of Medicine,

University of Occupational and Environmental Health, 1-1 Iseigaoka,

Yahatanishi-ku, Kitakyushu, Fukuoka, 807-8555, Japan.

Biologic drugs are effective but are also expensive, and it is

difficult to evaluate the duration of treatment. Infliximab, an

anti-TNFalpha antibody, suppresses arthritic activity and inhibits

bone destruction in patients with rheumatoid arthritis (RA). Here, we

document that infliximab could be discontinued after clinical

remission in RA patients. Among 172 patients with RA who reached

clinical remission following infliximab (3 mg/kg) and methotrexate

(MTX, >6 mg/w), nine patients with sustained remission discontinued

it. Clinical assessment was based on a disease activity score (DAS)

that included a 28-joint count/erythrocyte sedimentation rate

(DAS28-ESR). The disease was assessed before and after the start of

infliximab treatment, and concomitant drug treatment-in the order of

corticosteroid, nonsteroidal anti-inflammatory drugs (NSAIDs), and

disease-modifying anti-rheumatic drugs (DMARDs) other than MTX-was

gradually discontinued. We considered patients for discontinuation of

infliximab treatment after remission (DAS28-ESR < 2.6) had been

sustained for more than 24 weeks. The nine patients able to

discontinue treatment were all females, with a mean age of 53.8 years;

eight patients were at stage I or II. The mean duration of disease was

28.7 months, and these patients were on corticosteroid treatment

equivalent to a mean of 2.28 mg prednisolone (PSL). These nine

patients all met the remission standard-that DAS28-ESR < 2.6 for >/=24

weeks) -and so their treatment with concomitant drugs was

discontinued. After the discontinuation of infliximab, the mean period

of sustained remission was 14.2 months and the longest period was 29

months. The duration of disease was significantly shorter and the

points from Steinbrocker's stage-classification were significantly

lower in the infliximab-discontinued group than in the

infliximab-continued group. Strategic reductions and/or

discontinuations of concomitant treatment were performed in RA

patients who attained clinical remission (DAS28 < 2.6) through

treatment with infliximab and MTX. Nine patients successfully

discontinued infliximab after maintaining clinical remission for more

than 24 weeks. After infliximab was discontinued, clinical remission

and suppression of joint destruction were maintained with MTX alone,

especially in early RA patients.

PMID: 18535759

http://www.ncbi.nlm.nih.gov/pubmed/18535759

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