Background The goal of current rheumatoid arthritis management is to achieve remission or low disease activity1. However few studies have been performed on the management of patients in sustained remission, especially in daily practice.
Objectives The primary objective of the 3P survey was to assess the attitude of French rheumatologists to the prescription of synthetic and biologic DMARDs (and in particular treatment discontinuation procedures) in patients with RA in remission.
Results 326 rheumatologists replied. 67% had a private or mixed practice whereas 33% were exclusively hospital practitioners. 61.9% of rheumatologists were not aware of published controlled trials that assessed the reduction and/or discontinuation of biologics in patients with remission.
In practice, most rheumatologists waited until the patient has achieved remission for at least 6 months before reducing therapies (18.3%: 3 months / 46.9 %: 6 months / 25.7 %: 1 year). 60.8% of rheumatologists required prior discontinuation of glucocorticoids before reducing the disease-modifying therapy (25.9% accepted a dose <5 mg prednisone/day).
In patients with sustained remission and treated with a combination of a synthetic DMARD and a biologic agent, 55.8% planned to stop the biologic first whereas 44.2% stopped the synthetic DMARD.
Methotrexate dose, was reduced by 2.5 mg every two weeks in approximately half of the cases. Table 1 shows the rates of the different procedures used for stopping the 3 main TNF-alpha inhibitors. 63.7% of rheumatologists reported that the possibility of adjusting the dosage of biologic in patients in remission is an important criterion for the choice of initial biological therapy.
Conclusions In the 3P study, most of rheumatologists start to reduce therapies after 6 months of sustained remission, in increasing the interval between injections or reducing the dose of treatment. Possibility of adjusting the dosage is taken in consideration in the choice of initial biologic.
J. Smolen et al. ARD 2010
Disclosure of Interest R.-M. FLIPO Grant/research support from: Pfizer, Roceh, Chugai, Consultant for: Abbott, Astra-Zenica, BMS, Ipsen, menarini, MSD, Pfizer, Roche, Chugai, UCB, Jannssen-Cilag, Paid instructor for: Abbott, Astra-zenica, BMS, Expansciences, Ipsen, Menarini, MSD, Nordic-Pharma, Pfizer, Roceh, Chugai, Genzyme, UCB, A. CANTAGREL Grant/research support from: Chugai, Pfizer, UCB, Consultant for: BMS, Chugai, Roche, MSD, Novartis, Pfizer, UCB, Paid instructor for: Abbott, BMS, Chugai, MSD, Nordic-Pharma, Novartis, Pfizer, Roche, Sanofi-Aventis, UCB, C. CONTRE Employee of: Pfizer France, B. COMBE Grant/research support from: Pfizer, Roche, Chugai, Consultant for: BMS, Celgene, Merck, Novartis, Pfizer, Roche, Chugai, UCB, Speakers bureau: Merck, Pfizer, UCB