Who Stays in Remission after TNF's | Arthritis Information

Shorter duration of rheumatoid arthritis (RA) symptoms before beginning treatment, increased functional T-cells, higher levels of interleukin-10, and lower levels of interleukin-12 may help clinicians predict which RA patients will achieve sustained remission after stopping TNF-blockers, according to research presented at the American College of Rheumatology Annual Scientific Meeting in San Francisco, California.¹

“The current goal of treatment of RA is remission and is achievable on TNF-blockade therapy; however, guidelines regarding subsequent management and cessation of therapy are uncertain,” conclude the researchers who were led by Benazir Saleem, MD, of Leeds University in the UK. “Accurate predictors of sustained remission would allow informed decisions to be made on cessation or continuation of therapy.”

In the new study, 20 early RA patients in remission stopped TNF-blocker therapy; all patients continued methotrexate; 55% of these patients remained in remission for at least 1 year after stopping therapy. The clinical factors associated with sustained remission included shorter symptom duration prior to receiving therapy, 6 versus 9 months. Only one of eleven patients with >9 months of symptoms achieved sustained remission. Time to achieve remission after starting therapy was not associated with sustained remission, the study found.

Immunological features associated with sustained remission include lower inflammation-related cells (IRC) levels, higher naïve CD4+T cells, lower regulatory T-cells (Treg) (defined as CD25high Foxp3+T cells, but higher levels of the more important functional thymic derived Treg expressing CD62L) Moreover, circulating cytokines were also associated with sustained remission including higher levels of IL-10 and lower levels of IL-12.

“This study provides evidence for an immunological remission state and also a powerful argument for earlier treatment,” the study authors conclude.

Reference

1. Saleem B, Parmer R, Corsadden D, et al. Stopping TNF-blockade therapy in early RA: predictors of sustained remission. Presented at: American College of Rheumatology 2008 Annual Scientific Meeting; October 24-29, 2008; San Francisco, CA. Presentation L4.