title: Relapse rates in patients with rheumatoid arthritis in stable remission tapering or stopping antirheumatic therapy: interim results from the prospective randomised controlled RETRO study.
abstract: OBJECTIVE
  To prospectively analyse the risk for disease relapses in patients with rheumatoid arthritis (RA) in sustained remission, either continuing, tapering or stopping disease-modifying antirheumatic drugs (DMARDs) in a prospective randomised controlled trial.
  
  
  METHODS
  Reduction of Therapy in patients with Rheumatoid arthritis in Ongoing remission is a multicentre, randomised controlled, parallel-group phase 3 trial evaluating the effects of tapering and stopping all conventional and/or biological DMARDs in patients with RA in stable remission. Patients (disease activity score 28 (DAS28)<2.6 for least 6 months) were randomised into three arms, either continuing DMARDs (arm 1), tapering DMARDs by 50% (arm 2) or stopping DMARDs after 6 months tapering (arm 3). The primary endpoint was sustained remission during 12 months.
  
  
  RESULTS
  In this interim analysis, the first 101 patients who completed the study were analysed. At baseline, all patients fulfilled DAS28 remission and 70% also American College of Rheumatology- European League Against Rheumatism Boolean remission. 82.2% of the patients received methotrexate, 40.6% biological DMARDs and 9.9% other DMARDs. Overall, 67 patients (66.3%) remained in remission for 12 months, whereas 34 patients (33.7%) relapsed. The incidence of relapses was related to study arms (p=0.007; arm 1: 15.8%; arm 2: 38.9%; arm 3: 51.9%). Multivariate logistic regression identified anticitrullinated protein antibodies (ACPA) positivity (p=0.038) and treatment reduction (in comparison to continuation) as predictors for relapse (arm 2: p=0.012; arm 3: p=0.003).
  
  
  CONCLUSIONS
  This randomised controlled study testing three different treatment strategies in patients with RA in sustained remission demonstrated that more than half of the patients maintain in remission after tapering or stopping conventional and biological DMARD treatment. Relapses occurred particularly in the first 6 months after treatment reduction and were associated with the presence of ACPA.
  
  
  BACKGROUND
  2009-015740-42.
authors: Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany Department of Internal Medicine 2, The Vinforce Study Group, Saint Vincent Hospital, Vienna, Austria.
authors: Judith
authors: J
authors: Haschka
authors: Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany.
authors: Matthias
authors: M
authors: Englbrecht
authors: Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany.
authors: Axel J
authors: AJ
authors: Hueber
authors: Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany.
authors: Bernhard
authors: B
authors: Manger
authors: Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany.
authors: Arnd
authors: A
authors: Kleyer
authors: Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany.
authors: Michaela
authors: M
authors: Reiser
authors: Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany.
authors: Stephanie
authors: S
authors: Finzel
authors: Department of Internal Medicine 2, University of Wurzburg, Wurzburg, Germany.
authors: Hans-Peter
authors: HP
authors: Tony
authors: Department of Internal Medicine 2, University of Wurzburg, Wurzburg, Germany Rheumatology Practice, Erlangen, Germany.
authors: Stefan
authors: S
authors: Kleinert
authors: Department of Internal Medicine 2, University of Wurzburg, Wurzburg, Germany Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen, Germany.
authors: Martin
authors: M
authors: Feuchtenberger
authors: Department of Rheumatology and Clinical Immunology, Asklepios Medical Center, Bad Abbach, Germany.
authors: Martin
authors: M
authors: Fleck
authors: Rheumatology Practice, Bamberg, Germany.
authors: Karin
authors: K
authors: Manger
authors: Rheumatology Practice, Bayreuth, Germany.
authors: Wolfgang
authors: W
authors: Ochs
authors: Rheumatology Practice, Bayreuth, Germany.
authors: Matthias
authors: M
authors: Schmitt-Haendle
authors: Rheumatology Practice, Erlangen, Germany.
authors: Joerg
authors: J
authors: Wendler
authors: Rheumatology Practice, Erlangen, Germany.
authors: Florian
authors: F
authors: Schuch
authors: Rheumatology Practice, Erlangen, Germany.
authors: Monika
authors: M
authors: Ronneberger
authors: Department of Internal Medicine V, Division of Rheumatology, University of Heidelberg, Heidelberg, Germany ACURA Center for Rheumatic Diseases, Baden-Baden, Germany.
authors: Hanns-Martin
authors: HM
authors: Lorenz
authors: Rheumatology Practice, Nuremberg, Germany.
authors: Hubert
authors: H
authors: Nuesslein
authors: Schlosspark Clinic, Berlin, Germany.
authors: Rieke
authors: R
authors: Alten
authors: Rheumatology Practice, Hildesheim, Germany.
authors: Winfried
authors: W
authors: Demary
authors: Department of Internal Medicine 2, University of Tubingen, Tubingen, Germany.
authors: Joerg
authors: J
authors: Henes
authors: Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany.
authors: Georg
authors: G
authors: Schett
authors: Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany.
authors: Juergen
authors: J
authors: Rech
mesh_terms: D000328:Adult; D000368:Aged; D000906:Antibodies / Q000097:blood; D018501:Antirheumatic Agents / Q000008:administration & dosage*; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000188:drug therapy*; D001688:Biological Products / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D010456:Peptides, Cyclic / Q000276:immunology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012008:Recurrence; D028761:Withholding Treatment
chemical_list: D000906:Antibodies; D018501:Antirheumatic Agents; D001688:Biological Products; D010456:Peptides, Cyclic; C487763:cyclic citrullinated peptide; D008727:Methotrexate
keywords: DMARDs (biologic); DMARDs (synthetic); Disease Activity; Rheumatoid Arthritis; Treatment