Low rates of biologic-free clinical disease activity index remission maintenance after biologic disease-modifying anti-rheumatic drug discontinuation while in remission in a Japanese multicentre rheumatoid arthritis registry.
OBJECTIVE
To examine in detail the outcomes of biologic DMARD (bDMARD) discontinuation while in remission occurring in daily clinical practice settings. We examined a multicentre longitudinal registry of RA patients.


METHODS
We utilized data from the NinJa multicenter registry in Japan. Patients who used bDMARDs and had one or more successive visits in remission (defined by the clinical disease activity index (CDAI) ≤2.8) before discontinuation were included. The outcome of failing bDMARD-free disease control was defined as a composite of the following: re-use of bDMARDs, intensification of non-biologic DMARDs or of oral glucocorticoids, or loss of CDAI remission.


RESULTS
Among 1037 patients who initially achieved remission on bDMARDs, 46 patients discontinued bDMARDs while remaining in remission. Of these 46 subjects, 41 (89.1%) were female, the median disease duration was 6.0 years and 31 (70.5%) had reported radiographical erosions. At the baseline, 27 (58.7%) used MTX and 19 (41.3%) used oral glucocorticoids. The bDMARD-free remission failure rate was estimated to be 67.4% at 1 year and 78.3% at 2 years. Loss of remission and reuse of bDMARDs were the more common reasons for failure. Lower CDAI within the remission range was associated with fewer failures.


CONCLUSIONS
We found a high rate of failing bDMARD-free CDAI remission, indicating difficulty of maintaining disease control, even in patients who were in remission. Modification of non-biologic treatment was observed in some of the patients who remained in remission. Considering the cost of bDMARDs, such strategies for maintaining disease control after bDMARD discontinuation may be an important option.
Department of Epidemiology, Harvard T. H. Chan School of Public Health, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA, kazukiyoshida@mail.harvard.edu.
Kazuki
K
Yoshida
Immuno-Rheumatology Center, St Luke's International Hospital, Chuo-ku, Tokyo, Japan.
Mitsumasa
M
Kishimoto
Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA, Department of Internal Medicine III, Division of Rheumatology, Medical University Vienna, Vienna, Austria.
Helga
H
Radner
Department of Rheumatology, Kameda Medical Center, Kamogawa.
Kazuo
K
Matsui
Immuno-Rheumatology Center, St Luke's International Hospital, Chuo-ku, Tokyo, Japan.
Masato
M
Okada
Department of Clinical Research, National Hospital Organization Osaka Minami Medical Center, Kawachinagano, Osaka and.
Yukihiko
Y
Saeki
Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA.
Daniel H
DH
Solomon
Department of Rheumatology, Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Sagamihara, Japan.
Shigeto
S
Tohma
D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy*; D001685:Biological Factors / Q000627:therapeutic use*; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D012042:Registries; D012074:Remission Induction; D012720:Severity of Illness Index; D016896:Treatment Outcome; D028761:Withholding Treatment
D018501:Antirheumatic Agents; D001685:Biological Factors
antirheumatic agents; biologic antirheumatic agents; discontinuation; remission; rheumatoid arthritis