title: Sustained clinical remission and rate of relapse after tocilizumab withdrawal in patients with rheumatoid arthritis.
abstract: OBJECTIVE
  Data on when to stop use of biological agents in rheumatoid arthritis (RA) are scant. We assessed the length of remission and the rate of clinical relapse in patients with RA who had to discontinue treatment with tocilizumab (TCZ) because of the ending of longterm (5 yrs) open-label clinical trials.
  
  
  METHODS
  All patients at 2 participating centers in Mexico were in remission, defined as Disease Activity Score 28 ≤ 2.6, with no swollen joints at the time of the last TCZ infusion. Patients were followed thereafter every 8 weeks for 12 months or until relapse. Relapse was defined as the presence of ≥ 1 swollen joint. Doses of methotrexate and antiinflammatory drugs were not changed during the followup period.
  
  
  RESULTS
  Forty-five patients were analyzed, 87% were women (mean age 52 yrs, mean disease duration 14 yrs). During the 12 months of followup, 44% of patients maintained remission. Relapses occurred in 56% of patients: 14 during the first 3 months after the last TCZ administration. Retreatment using other agents achieved low disease activity or remission.
  
  
  CONCLUSIONS
  Longterm clinical remission is possible in a number of patients with RA after suspension of TCZ. This effect has also been reported with other biologic agents. Additional data are required to support recommendations for discontinuing a biological agent after achieving remission.
authors.affiliation: Unidad de Investigación en Enfermedades Crónico-Degenerativas, Guadalajara, Mexico.
authors.forename: Luis
authors.initials: L
authors.lastname: Aguilar-Lozano
authors.forename: Jose Dionisio
authors.initials: JD
authors.lastname: Castillo-Ortiz
authors.forename: Cesar
authors.initials: C
authors.lastname: Vargas-Serafin
authors.forename: Jorge
authors.initials: J
authors.lastname: Morales-Torres
authors.forename: Adriana
authors.initials: A
authors.lastname: Sanchez-Ortiz
authors.forename: Carlos
authors.initials: C
authors.lastname: Sandoval-Castro
authors.forename: Jorge
authors.initials: J
authors.lastname: Padilla-Ibarra
authors.forename: Claudia
authors.initials: C
authors.lastname: Hernandez-Cuevas
authors.forename: Cesar
authors.initials: C
authors.lastname: Ramos-Remus
mesh_terms: D000328:Adult; D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D012008:Recurrence; D012074:Remission Induction; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; C502936:tocilizumab; D008727:Methotrexate
keywords: BIOLOGICAL AGENT; RELAPSE; REMISSION; RHEUMATOID ARTHRITIS; TOCILIZUMAB; WITHDRAWAL