Table 2

Treatment details of the 115 patients who discontinued all DMARDs due to sustained clinical remission

Sustained drug-free remission (n=59)Restarted (n=53)Lost to follow-up (n=3)
Sequential monotherapy
 MTX monotherapy*1191
 SSA monotherapy041
 Leflunomide monotherapy300
 MTX + IFX§020
 Next steps000
Step-up combination therapy
 MTX monotherapy*841
 MTX + SSA430
 MTX + SSA + HCQ210
 MTX + SSA + HCQ + pred010
 Next steps000
Initial combination with prednisone
 MTX + SSA + pred**1012††0
 MTX + CSA + pred‡‡020
 Next steps000
Initial combination with infliximab
 MTX + IFX§19130
 SSA monotherapy220
 Next steps000
  • For each treatment group, the medication step at which the drug-free remission was reached is shown separately for the sustained drug-free remission patients, restarters and patients lost to follow-up.

  • Before the protocol allowed discontinuation of the last DMARD, patients had to taper their medication to DMARD monotherapy in a maintenance dose. If subsequently DAS fell to <1.6 for ≥6 months, the last DMARD could be tapered/discontinued. Details on tapering and discontinuation are shown below.

  • * First MTX was tapered to 10 mg/week if DAS ≤2.4 during ≥6 months. Subsequently, MTX was tapered to 0 if DAS <1.6 during ≥6 months on MTX 10 mg/week.

  • SSA was tapered to 0 if DAS <1.6 during ≥6 months on SSA 2000 mg/day.

  • First leflunomide was tapered to 10 mg every other day if DAS ≤2.4 during ≥6 months. Subsequently, leflunomide was discontinued if DAS <1.6 during ≥6 months on leflunomide 10 mg every other day.

  • § First IFX was discontinued and MTX was tapered to 10 mg/week if DAS ≤2.4 during ≥6 months. Subsequently, MTX was tapered to 0 if DAS <1.6 during ≥6 months on MTX 10 mg/week.

  • First, the step-up combination was tapered to MTX monotherapy and then to MTX 10 mg/week if DAS ≤2.4 during ≥6 months. Subsequently, MTX was tapered to 0 if DAS <1.6 during ≥6 months on MTX 10 mg/week.

  • ** First prednisolone and MTX were tapered to 0 if DAS ≤2.4 during ≥6 months. Subsequently, SSA was tapered to 0 if DAS <1.6 during ≥6 months on SSA 2000 mg/day.

  • †† One patient tapered to MTX 10 mg/week due to SSA toxicity.

  • ‡‡ First prednisolone and CSA were tapered to 0 if DAS ≤2.4 during ≥6 months. Subsequently, MTX was tapered to 0 if DAS <1.6 during ≥6 months on MTX 10 mg/week.

  • CSA, ciclosporin A; DMARD, disease-modifying antirheumatic drug; HCQ, hydroxychloroquine; pred, prednisolone; IFX, infliximab; MTX, methotrexate; SSA, sulfasalazine.