Discontinuing TNF therapy in patients in remission | Arthritis Information

Share
 

Effect of discontinuing TNFα antagonist therapy in patients with remission of rheumatoid arthritis

 

Olivier Brocqa, b,

aService de Rhumatologie, Hôpital L'Archet 1, 06200 CHU Nice, Université Nice, Sophia Antipolis, France

bRhumatologie, Hôpital Princesse Grace De Monaco, 98000 Monaco


Accepted 14 November 2008. 
Available online 11 April 2009.

Abstract

Objective

The objective of this study was to determine the time to relapse after tumor necrosis factor α (TNFα) antagonist discontinuation in patients with remission of rheumatoid arthritis (RA).

Methods

Among 304 patients taking TNFα antagonist therapy for RA, 21 achieved a remission and were taken off the TNFα antagonist. Remission was defined as DAS28 < 2.6 for at least 6 months without nonsteroidal inflammatory drugs or more than 5 mg of prednisone per day but with disease-modifying antirheumatic drug (DMARD) therapy if needed. The same TNFα antagonist was restarted in the event of a relapse (DAS28 > 3.2).

Results

The 21 patients had a mean age of 61 years, a mean disease duration of 11.3 years, and a mean remission duration at TNFα antagonist discontinuation of 19.2 months. The TNFα antagonist was infliximab in 2 patients, adalimumab in 5, and etanercept in 14; and 14 patients were taking a concomitant DMARD. The number of patients still in remission after TNFα antagonist discontinuation was 9/20 after 6 months and 5/20 after 12 months. Mean time to relapse was 14.7 weeks. While off TNFα antagonist therapy, 3 of the 5 relapse-free patients after 12 months were on DMARD therapy, compared to 11 of the 15 patients who relapsed. Compared to the 15 patients who relapsed, the 5 relapse-free patients had a longer time on TNFα antagonist therapy (56 months vs. 35 months, P = 0.012) and a longer time in remission on TNFα antagonist therapy (35 months vs.14.5 months, P = 0.04). The 15 patients who relapsed consistently achieved a remission after resuming TNFα antagonist therapy; the remission occurred within 2 months in 13 patients.

Conclusion

TNFα antagonist discontinuation in patients in remission of RA was followed by a relapse within 12 months in 75% of cases. Relapsing patients responded well to resumption of the same TNFα antagonist.

 
Lynn492009-04-20 05:19:52I hope you and LinB and others can be the 25%

Thanks so much for this, Lynn.  I've been searching for something, anything that is hopeful.  I also liked the mean age of the participants - 61 years old.  This gives me a lift and hope.  Lindy

I will admit that I'm hoping to get things under control with Humira so I can have a third child. I realize I am lucky to have 2 healthy ones and don't want to press my luck.  I am not 100% better on Humira yet but much better than I have been, and I am hoping I continue to get better, think about a break from it in the next year. 

I just had my Rd appt last week and was wondering about this subject, I have been on Remicade for 1 year and have been feeling good for the last couple of months so much so that Rd has me going every9 weeks instead of 8.he says if I continue to progress they will go eventually to every12 weeks then take me off....guess I always thought once you started these meds that you had to be on them forever...so glad that that might not be the case... thanks for posting You are all very welcome   Glad I could be of some help...

For those of us contemplating the biologics this is good news. "...The 15 patients who relapsed consistently achieved a remission after resuming TNFα antagonist therapy; the remission occurred within 2 months in 13 patients." Bumping for the newbies
Copyright ArthritisInsight.com