Objectives Currently there are no guidelines regarding the possibility and the timing of the discontinuation of biological therapy in patients with sustained remission. The authors’ aim was to assess the disease course after permanent stopping of the biologics in three Hungarian arthritis centres.
Methods In this retrospective, multicenter cohorts study, 126 patients with rheumatoid arthritis (RA) (average age: 60 years), 38 patients with ankylosing spondylitis (AS) (average age: 50 years) and 11 patients with psoriatic arthritis (average age: 54 years) were enrolled in whom biological therapy had permanently been stopped because of several reasons. Data on the reason of cessation of biological therapy, and on the subsequent disease course were collected.
Results The reasons of stopping the biological therapy were: side effect (6,8%), allergic reaction (11,4 %), infections (14,2 %), tumor appearance or tumor search (12 %), permanent remission (10,2 %), family planning (4 %), ineffectivity (16 %), poor compliance (15,4 %), and other reasons (9,7 %). When the biological therapy was stopped, RA disease activity was low in 38,8 % of the patients (DAS-28< 3,2), and high in 19 % (DAS-28 >5,1). In AS, 13,1 % of the patients had low (BASDAI < 2,0), whereas 44,7 % had high activity (BASDAI > 4,1). After an average of 22 months, 37 % of the RA patients remained in remission, and 22 % had high disease activity. In AS, an average of 19 months 17,6 % of the patients had low disease activity., and 52,9 % had high. 55,5 % of the RA patients took synthetic DMARDs, and 27,7 % corticosteroids after the withdrawal of biologics. During the follow-up relapse occured in 31 % of the RA, and 37 % of the AS patients. The duration of biological therapy and low disease activity at cessation predicted a sustained biologic-free remission.
Conclusions After permanently stopping the biological therapy, considerable proportion of RA patients may remain in sustained remission, whereas the likelihood of long-term low disease activity is lower in AS patients. Identification of predictors of a sustained biologic-free remission should be of high priority.
Disclosure of Interest None Declared
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.