Background Currently, remission of rheumatoid arthritis (RA) is a goal that can be achieved in a relatively large number of cases thanks to the introduction of therapies involving biological agents. Thus, the follow-on question is then what minimal therapeutic regimen will sustain remission of RA.
Objectives Ideally, the ultimate goal of therapy is achieving drug-free remission. As a precursor to achieving that goal, the current study examined how effective an approach intending to achieve biologic-free remission was in patients with RA.
Methods Of 80 patients with RA who were administered etanercept (ETN), subjects were 22 patients with RA who had sustained clinical remission (DAS28-ESR <2.6) for 6 months or longer despite steroids being tapered and ultimately discontinued and ETN being tapered to 25 mg/2 weeks. ETN was discontinued for these 22 patients with their consent. ETN and steroids were not administered again after the two were discontinued. In accordance with a study 1 year after discontinuation, patients were divided into patients in remission (Group A) and patients who had a flare-up (DAS28-ESR ≥3.2) and were restarted on ETN (Group B). Patient characteristics were compared. In addition to duration of illness, age, the period prior to discontinuation of ETN, the concomitant dose of methotrexate (MTX) during discontinuation of ETN, DAS28-ESR, functional disability index (HAQ-DI), and rheumatoid factor (RF) and matrix metalloproteinase-3 (MMP-3) levels were considered to be factors affecting whether or not remission was sustained. Thus, these factors were analyzed. The Mann-Whitney U-test was used to compare the 2 groups, and changes in DAS28-ESR from discontinuation of ETN until 1 year later were subjected to a Wilcoxon signed-rank test.
Results There were no dropouts, and there were 10 patients in Group A (3 males, 7 females) and 12 in Group B (3 males, 9 females). There were no significant differences in age upon start of ETN and the period prior to discontinuation, but Group A had a significantly shorter duration of illness (3.12 years for Group A vs. 15.5 years for Group B, p<0.01). The concomitant dose of methotrexate during discontinuation of ETN was significantly greater (7.6 mg for Group A vs. 5.8 mg for Group B, p<0.01) for Group A than for Group B. There were no significant differences in RF and MMP-3 levels and the HAQ-DI immediately prior to discontinuation of ETN, but Group A had a significantly lower DAS28-ESR (1.40 for Group A vs. 2.01 for Group B, p<0.05). One year after discontinuation, Group A had a DAS28-ESR of 1.59, so there were no significant changes, but Group B had a significantly higher (p<0.01) DAS28-ESR of 2.61.
Conclusions The current study involved a small patient sample. In patients suffering from RA for a short period of time, ETN was tapered to 25 mg/2 weeks without a 6–8-mg decrease in the dose of MTX in the interim and clinical remission was sustained for 6 months or longer. Results suggested that clinical remission could be sustained for a year or longer in these patients even after ETN is discontinued. However, some patients were subsequently found to have flare-ups of arthritis and greater joint destruction, so tight control is needed.
Klarenbeek, N.B. et al. Discontinuing treatment in patients with rheumatoid arthritis in sustained clinical remission: exploratory analyses from the Best study. Ann. Rheum. Dis 70, 315–319 (2011)
Disclosure of Interest None Declared