title: Discontinuation of tumour necrosis factor inhibitors in patients with rheumatoid arthritis in low-disease activity: persistent benefits. Data from the Corrona registry.
abstract: BACKGROUND
  There is increasing interest in discontinuing biological therapies for patients with rheumatoid arthritis (RA) achieving good clinical responses, provided patients maintain clinical benefit.
  
  
  METHODS
  We assessed patients with RA from the Corrona registry who discontinued treatment with their first tumour necrosis factor inhibitor (TNFi) while in low-disease activity (LDA) or lower levels of disease activity. Patients were followed until they lost clinical benefit, defined as increased disease activity or change in RA medications. Duration of maintenance of clinical benefit was estimated using the Kaplan-Meier method. Cox proportional hazard models were assessed to identify factors related to maintenance of benefit.
  
  
  RESULTS
  We identified 717 eligible patients with RA from 35,656 in the Corrona registry. At discontinuation, patients had a median RA duration of 8 years, mean clinical disease activity score of 4.3±0.11; 41.8% were using TNFi as monotherapy. 73.4% of patients maintained benefit for >12 months after discontinuing therapy and 42.2% did so through 24 months. Factors predictive of maintaining clinical benefit in multivariate analysis included lower disease activity, less pain and better functional status at the time of TNFi discontinuation. Among 301 patients initiating their first TNFi within the registry, faster responders (ie, those who achieved LDA in 4 months or less) did better than slower responders (HR 1.54 (95% CI 1.17 to 2.04)). RA disease duration did not affect maintenance of clinical benefit.
  
  
  CONCLUSIONS
  Discontinuation of a first course of TNFi may be associated with persistent clinical benefit. Half of patients maintained response through 20 months. Several patient characteristics may help predict persistent benefit.
authors.affiliation: University of California San Diego, San Diego, La Jolla, California, USA.
authors.forename: Arthur
authors.initials: A
authors.lastname: Kavanaugh
authors.affiliation: University of California San Diego, San Diego, La Jolla, California, USA San Diego Veterans Affairs Medical Center, San Diego, La Jolla, California, USA.
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Lee
authors.affiliation: University of Alabama at Birmingham, Birmingham, USA.
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Curtis
authors.affiliation: NYU School of Medicine, New York, New York, USA Corrona, LLC, Southborough, Massachusetts, USA.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Greenberg
authors.affiliation: Corrona, LLC, Southborough, Massachusetts, USA Albany Medical College, Albany, New York, USA.
authors.forename: Joel M
authors.initials: JM
authors.lastname: Kremer
authors.affiliation: Universidad de Chile, Santiago, Chile.
authors.forename: Lilian
authors.initials: L
authors.lastname: Soto
authors.affiliation: Corrona, LLC, Southborough, Massachusetts, USA Department of Epidemiology, UT MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Carol J
authors.initials: CJ
authors.lastname: Etzel
authors.affiliation: Corrona, LLC, Southborough, Massachusetts, USA.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Cox
authors.affiliation: Brigham and Women's Hospital, Boston, Massachusetts, USA Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA.
authors.forename: Kazuki
authors.initials: K
authors.lastname: Yoshida
authors.affiliation: Corrona, LLC, Southborough, Massachusetts, USA UMASS Medical School, Worcester, Massachusetts, USA.
authors.forename: George W
authors.initials: GW
authors.lastname: Reed
authors.affiliation: Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Solomon
mesh_terms: D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D060046:Maintenance Chemotherapy / Q000379:methods*; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012042:Registries; D012074:Remission Induction; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha; D008727:Methotrexate
keywords: DMARDs (biologic); Rheumatoid Arthritis; TNF-alpha