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

Objective: The objective of this study was to determine the time to relapse after tumor necrosis factor alpha (TNF alpha) antagonist discontinuation in patients with remission of rheumatoid arthritis (RA). Methods: Among 304 patients taking TNF alpha antagonist therapy for RA, 21 achieved a remission and were taken off the TNF alpha 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 TNF alpha 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 TNF alpha antagonist discontinuation of 19.2 months. The TNF alpha 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 TNF alpha antagonist discontinuation was 9/20 after 6 months and 5/20 after 12 months. Mean time to relapse was 14.7 weeks. While off TNF alpha 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 TNF alpha antagonist therapy (56 months vs. 35 months, P = 0.012) and a longer time in remission on TNF alpha antagonist therapy (35 months vs. 14.5 months, P = 0.04). The 15 patients who relapsed consistently achieved a remission after resuming TNF alpha antagonist therapy; the remission occurred within 2 months in 13 patients. Conclusion: TNF alpha 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 TNF alpha antagonist. (C) 2009 Societe Francaise de Rhumatologie. Published by Elsevier Masson SAS. All rights reserved.