Therapeutic strategy for rheumatoid arthritis patients who have achieved remission

Publication date: December 2018Source: Joint Bone Spine, Volume 85, Issue 6Author(s): Bruno FautrelAbstractOnce remission or low disease activity (LDA) is attained in established rheumatoid arthritis (RA) patients, attempting disease-modifying anti-rheumatic drug (DMARD) tapering appears to be a viable option to avoid patient overtreatment. Potential benefits include reduction in the treatment burden and the risk of adverse events, although the latter has not been demonstrated convincingly. The feasibility of DMARD discontinuation has been tested in numerous studies or trials. All have revealed a high risk of relapse, ranging from 56%–87% at one year. Although remission/LDA can usually be re-established by re-initiation of the previous treatment, the associated risk appears to be more harmful than beneficial. DMARD tapering, either by dose reduction or by injection spacing, is conceptually more acceptable and two superiority randomized controlled trials (RCTs) comparing half-dose etanercept to full-dose continuation demonstrated no significant difference at one year. By contrast, two equivalence RCTs that tested disease activity-guided dose optimization by progressive etanercept and adalimumab injection spacing versus continuation revealed an increased risk of acute flare. Interestingly, one of these also demonstrated the equivalence of increasing injection spacing and standard of care in terms of recurrent flare and overall disease activity over the 18-month follow-up peri...
Source: Joint Bone Spine - Category: Orthopaedics Source Type: research