RESEARCH - Discontinuing treatment in patients with RA in sustained clinical remission: BeSt

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Ann Rheum Dis. 2011 Feb;70(2):315-9. Epub 2010 Nov 10.

Discontinuing treatment in patients with rheumatoid arthritis in

sustained clinical remission: exploratory analyses from the BeSt

study.

Klarenbeek NB, van der Kooij SM, Güler-Yüksel M, van Groenendael JH,

Han KH, Kerstens PJ, Huizinga TW, Dijkmans BA, Allaart CF.

Leiden University Medical Center, Leiden, The Netherlands.

Abstract

OBJECTIVES: To determine the relapse rate after discontinuing

treatment in patients with rheumatoid arthritis (RA) in sustained

clinical remission, to identify predictors of a relapse and to

evaluate treatment response after restarting treatment.

METHODS: Five-year data from the BeSt study were used, in which 508

patients with recent-onset RA were randomised into four dynamic

treatment strategies, aiming at a disease activity score (DAS) ≤ 2.4.

When DAS was < 1.6 for ≥ 6 months, the last disease-modifying

antirheumatic drug (DMARD) was tapered and discontinued. If DAS

increased to ≥ 1.6, the last DMARD was immediately reintroduced.

RESULTS: During a 5-year period, 115/508 patients (23%) achieved

drug-free remission. Of these, 53 patients (46%) restarted treatment

because the DAS was ≥ 1.6 after a median of 5 months, 59 patients

(51%) remained in drug-free remission for a median duration of 23

months and 3 (3%) were lost to follow-up. In those who restarted

treatment, mean (SD) DAS increased from 1.13 (0.73) at remission

before tapering to 2.18 (0.65) at restart, reflecting an increase in

all four components of DAS. Multivariable predictors for restarting

treatment were anti-cyclic citrullinated peptide (anti-CCP), last

DMARD sulfasalazine, low baseline Health Assessment Questionnaire

score and high mean DAS until remission. Of the 53 patients who

restarted treatment, 39 (74%) again achieved remission 3-6 months

after the restart. The median (IQR) damage progression in those who

restarted treatment during the year of DAS increase was 0 (0-1)

Sharp-van der Heijde units.

CONCLUSION: During 5 years DAS steered treatment, nearly 25% of

patients with RA achieved drug-free remission; 46% restarted DMARD

monotherapy because of a relapse, the majority of whom again achieved

clinical remission within 3-6 months without showing radiological

progression during the relapse.

PMID: 21068104

http://www.ncbi.nlm.nih.gov/pubmed/21068104

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