RESEARCH - Discontinuation of Remicade after attaining low disease activity in patients with RA: RRR

[Guest guest]

Ann Rheum Dis 2010;69:1286-1291 doi:10.1136/ard.2009.121491

Clinical and epidemiological research

Extended report

Discontinuation of infliximab after attaining low disease activity in

patients with rheumatoid arthritis: RRR (remission induction by

Remicade in RA) study

Y Tanaka1, T Takeuchi2, T Mimori3, K Saito1, M Nawata1, H Kameda4, T

Nojima3, N Miyasaka5, T Koike6, for the RRR study investigators

+ Author Affiliations

1The First Department of Internal Medicine, University of Occupational

and Environmental Health, Japan, Kitakyushu, Japan

2Division of Rheumatology and Clinical Immunology, Department of

Internal Medicine, Faculty of Medicine, Keio University, Tokyo, Japan

3Department of Rheumatology and Clinical Immunology, Kyoto University

Graduate School of Medicine, Kyoto, Japan

4Department of Rheumatology/Clinical Immunology, Saitama Medical

Centre, Saitama Medical University, Kawagoe, Japan

5Department of Medicine and Rheumatology, Tokyo Medical and Dental

University, Tokyo, Japan

6Department of Medicine II, Hokkaido University, Sapporo, Japan

Accepted 9 January 2010

Published Online First 1 April 2010

Abstract

Background Tumour necrosis factor (TNF) inhibitors enable tight

control of disease activity in patients with rheumatoid arthritis

(RA). Discontinuation of TNF inhibitors after acquisition of low

disease activity (LDA) is important for safety and economic reasons.

Objective To determine whether infliximab might be discontinued after

achievement of LDA in patients with RA and to evaluate progression of

articular destruction during the discontinuation.

Methods 114 patients with RA who had received infliximab treatment,

and whose Disease Activity Score, including a 28-joint count (DAS28)

was <3.2 (LDA) for 24 weeks, were studied.

Results The mean disease duration of the 114 patients was 5.9 years,

mean DAS28 5.5 and mean modified total Sharp score (mTSS) 63.3. After

maintaining LDA for >24 weeks by infliximab treatment, the drug was

discontinued and DAS28 in 102 patients was evaluated at year 1.

Fifty-six patients (55%) continued to have DAS28<3.2 and 43% reached

DAS<2.6 at 1 year after discontinuing infliximab. For 46 patients

remission induction by Remicade in RA (RRR) failed: disease in 29

patients flared within 1 year and DAS28 was >3.2 at year 1 in 17

patients. Yearly progression of mTSS (ΔTSS) remained <0.5 in 67% and

44% of the RRR-achieved and RRR-failed groups, respectively. The

estimated ΔmTSS was 0.3 and 1.6 and Health Assessment

Questionnaire-Disability Index was 0.174 and 0.614 in the RRR-achieved

and RRR-failed groups, respectively, 1 year after the discontinuation.

Conclusion After attaining LDA by infliximab, 56 (55%) of the 102

patients with RA were able to discontinue infliximab for >1 year

without progression of radiological articular destruction.

http://ard.bmj.com/content/69/7/1286.abstract

Not an MD