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Tapering of TNF inhibitors (TNFi) is feasible in many patients with rheumatoid arthritis (RA), but sometimes leads to flaring. TNFi trough serum levels and antidrug antibodies (ADAs) have been proposed as predictors for successful dose reduction or discontinuation,1–3 suggesting that: (1) a patient with low or undetectable serum levels (with or without ADAs) should be able to successfully stop the TNFi and (2) a patient with high serum levels should be able to reduce the dose. As obtaining trough levels is often not practical, our aim was to investigate whether random timed serum drug levels and ADAs of adalimumab and etanercept are predictive for successful dose reduction or discontinuation of these TNFi in patients with RA doing well.
For these analyses 118 patients with RA from an open randomised clinical trial investigating a dose reduction strategy of adalimumab or etanercept with 18 months follow-up were included.4 Serum samples were collected at baseline (before start of dose reduction) at a regular visit, unrelated to time …
Funding This study received no external funding.
Contributors NvH, AAdB, AvdM, BJFvdB, FHJvdH, CAMB, RFvV and JWB were involved in the study design. NvH, CAMB, AAdB, AvdM and FHJvdH were involved in the data collection. NvH, AAdB, CAMB, BJFvdB and AvdM performed the data analyses. All authors were involved in writing, revision and final approval of the manuscript.
Competing interests JWB reports grants and personal fees from AbbVie, BMS, Roche, UCB, Pfizer, MSD, during the conduct of the study. RFvV reports grants from AbbVie, BMS, GSK, Pfizer, Roche, UCB, personal fees from AbbVie, Biotest, BMS, Crescendo, GSK, Janssen, Lilly, Merck, Pfizer, Roche, UCB, Vertex, outside the submitted work.
Ethics approval Commissie Mensgebonden Onderzoek region Arnhem-Nijmegen.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement The authors commit to making the relevant anonymised patient level data available on reasonable request.