RESEARCH - Effect of discontinuing TNF-alpha antagonist therapy in RA patients in remission

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Joint Bone Spine. 2009 Apr 9.

Effect of discontinuing TNFalpha antagonist therapy in patients with

remission of rheumatoid arthritis.

Brocq O, Millasseau E, Albert C, Grisot C, Flory P, Roux CH, Euller-Ziegler L.

Service de Rhumatologie, Hôpital L'Archet 1, 06200 CHU Nice,

Université Nice, Sophia Antipolis, France; Rhumatologie, Hôpital

Princesse Grace De Monaco, 98000 Monaco.

OBJECTIVE: The objective of this study was to determine the time to

relapse after tumor necrosis factor alpha (TNFalpha) antagonist

discontinuation in patients with remission of rheumatoid arthritis

(RA).

METHODS: Among 304 patients taking TNFalpha antagonist therapy for RA,

21 achieved a remission and were taken off the TNFalpha antagonist.

Remission was defined as DAS28<2.6 for at least 6months without

nonsteroidal inflammatory drugs or more than 5mg of prednisone per day

but with disease-modifying antirheumatic drug (DMARD) therapy if

needed. The same TNFalpha antagonist was restarted in the event of a

relapse (DAS28>3.2).

RESULTS: The 21 patients had a mean age of 61years, a mean disease

duration of 11.3years, and a mean remission duration at TNFalpha

antagonist discontinuation of 19.2months. The TNFalpha antagonist was

infliximab in 2 patients, adalimumab in 5, and etanercept in 14; and

14 patients were taking a concomitant DMARD. The number of patients

still in remission after TNFalpha antagonist discontinuation was 9/20

after 6months and 5/20 after 12months. Mean time to relapse was

14.7weeks. While off TNFalpha antagonist therapy, 3 of the 5

relapse-free patients after 12months were on DMARD therapy, compared

to 11 of the 15 patients who relapsed. Compared to the 15 patients who

relapsed, the 5 relapse-free patients had a longer time on TNFalpha

antagonist therapy (56months vs. 35months, P=0.012) and a longer time

in remission on TNFalpha antagonist therapy (35months vs.14.5months,

P=0.04). The 15 patients who relapsed consistently achieved a

remission after resuming TNFalpha antagonist therapy; the remission

occurred within 2months in 13 patients.

CONCLUSION: TNFalpha antagonist discontinuation in patients in

remission of RA was followed by a relapse within 12months in 75% of

cases. Relapsing patients responded well to resumption of the same

TNFalpha antagonist.

PMID: 19362504

http://www.ncbi.nlm.nih.gov/pubmed/19362504

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