Enschede, The Netherlands—Should rheumatoid arthritis (RA) patients in remission or with stable low disease activity continue TNF-inhibiting biologics (TNFi)?

That was the question raised by a study published recently in the journal Arthritis & Rheumatology. Dutch researchers from the University of Twente looked at the safety and effectiveness of stopping the effective therapy.

The multicenter open-label randomized, controlled trial included patients diagnosed with RA according to the ACR 1987 criteria, using a TNFi for at least 1 year with stable dose disease-modifying antirheumatic drugs (DMARDs) over the last 6 months and with a disease activity score (DAS)28 of less than 3.2 during the same time period.

Patients were randomized to either stop or continue their current TNFi in a 2:1 ratio, with flare defined as DAS28 of more than 3.2 with an increase of greater or equal to 0.6 compared to baseline.

With 531 patients allocated to the stop group and 286 to the TNFi continuation group, after 12 months, more patients in the stop group, 51.2%, had experienced a flare than in the continuation group, 18.2%—with a hazard ratio of 3.50. In addition, results indicate the stop group had more hospitalizations than the continuation group—6.4% versus 2.4%.

Mean DAS28 scores in the stop group were significantly higher during the follow-up period compared with the continuation group. Of the 195 patients that restarted TNFi within 26 weeks after a flare, 84.6% had regained a DAS28 of less than 3.2 by 6 months later, with a median time to regain of 12 weeks.

“Stopping TNFi treatment in established RA patients in remission or stable low disease activity results in substantially more flares than continuing,” study authors conclude.

Research suggests that continuing TNFi treatment isn’t without consequence, however. Treatment has been linked to increased risks for infections, and long-term use has been associated with increased risks of lymphoma and skin cancer.

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