RT Journal Article
SR Electronic
T1 Relapse rates in patients with rheumatoid arthritis in stable remission tapering or stopping antirheumatic therapy: interim results from the prospective randomised controlled RETRO study
JF Annals of the Rheumatic Diseases
JO Ann Rheum Dis
FD BMJ Publishing Group Ltd and European League Against Rheumatism
SP 45
OP 51
DO 10.1136/annrheumdis-2014-206439
VO 75
IS 1
A1 Judith Haschka
A1 Matthias Englbrecht
A1 Axel J Hueber
A1 Bernhard Manger
A1 Arnd Kleyer
A1 Michaela Reiser
A1 Stephanie Finzel
A1 Hans-Peter Tony
A1 Stefan Kleinert
A1 Martin Feuchtenberger
A1 Martin Fleck
A1 Karin Manger
A1 Wolfgang Ochs
A1 Matthias Schmitt-Haendle
A1 Joerg Wendler
A1 Florian Schuch
A1 Monika Ronneberger
A1 Hanns-Martin Lorenz
A1 Hubert Nuesslein
A1 Rieke Alten
A1 Winfried Demary
A1 Joerg Henes
A1 Georg Schett
A1 Juergen Rech
YR 2016
UL http://ard.bmj.com/content/75/1/45.abstract
AB Objective To prospectively analyse the risk for disease relapses in patients with rheumatoid arthritis (RA) in sustained remission, either continuing, tapering or stopping disease-modifying antirheumatic drugs (DMARDs) in a prospective randomised controlled trial.Methods Reduction of Therapy in patients with Rheumatoid arthritis in Ongoing remission is a multicentre, randomised controlled, parallel-group phase 3 trial evaluating the effects of tapering and stopping all conventional and/or biological DMARDs in patients with RA in stable remission. Patients (disease activity score 28 (DAS28)<2.6 for least 6 months) were randomised into three arms, either continuing DMARDs (arm 1), tapering DMARDs by 50% (arm 2) or stopping DMARDs after 6 months tapering (arm 3). The primary endpoint was sustained remission during 12 months.Results In this interim analysis, the first 101 patients who completed the study were analysed. At baseline, all patients fulfilled DAS28 remission and 70% also American College of Rheumatology- European League Against Rheumatism Boolean remission. 82.2% of the patients received methotrexate, 40.6% biological DMARDs and 9.9% other DMARDs. Overall, 67 patients (66.3%) remained in remission for 12 months, whereas 34 patients (33.7%) relapsed. The incidence of relapses was related to study arms (p=0.007; arm 1: 15.8%; arm 2: 38.9%; arm 3: 51.9%). Multivariate logistic regression identified anticitrullinated protein antibodies (ACPA) positivity (p=0.038) and treatment reduction (in comparison to continuation) as predictors for relapse (arm 2: p=0.012; arm 3: p=0.003).Conclusions This randomised controlled study testing three different treatment strategies in patients with RA in sustained remission demonstrated that more than half of the patients maintain in remission after tapering or stopping conventional and biological DMARD treatment. Relapses occurred particularly in the first 6 months after treatment reduction and were associated with the presence of ACPA.Trial registration number 2009-015740-42.