Predictors of biologic-free disease control in patients with rheumatoid arthritis after stopping tumor necrosis factor inhibitor treatment
Moghadam, Marjan Ghiti; Lamers-Karnebeek, Femke B.G.; Vonkeman, Harald E.; ten Klooster, Peter M.; Tekstra, Janneke; van Schaeybroeck, Barbara; Klaasen, Ruth; van Onna, Marieke; Bernelot Moens, Hein J.; Visser, Henk; Schilder, Annemarie M.; Kok, Marc R.; Landewé, Robert B.M.; van Riel, Piet L.C.M.; van de Laar, Mart A.F.J.; Jansen, Tim L.; behalf of the Dutch National POET Collaboration
(2019) BMC Rheumatology, volume 3, issue 1
(Article)
Abstract
Background: The aim of this study was to identify predictors of prolonged disease control after discontinuation of tumor necrosis factor inhibitor (TNFi) treatment in patients with rheumatoid arthritis (RA). Methods: Post-hoc analysis of 439 RA patients (67.3% rheumatoid factor positive) with longstanding RA in remission or with stable low disease
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activity, randomized to stopping TNFi treatment in the multicenter POET trial. Prolonged acceptable disease control was defined as not restarting TNFi treatment within 12 months after stopping. Baseline demographic and disease-related variables were included in univariate and multivariate logistic regression analysis for identifying predictors of relapse. Results: One year after baseline, 220 patients (50.1%) had not restarted TNFi treatment. Use of an anti-TNF monoclonal antibody (versus a receptor antagonist, OR = 2.41; 95% CI: 1.58-3.67), ≤10 yrs. disease duration (OR = 2.15; 95% CI: 1.42-3.26) and low or moderate multi-biomarker disease activity (MBDA) scores (OR = 2.00; 95% CI: 1.10-3.64) at baseline were independently predictive of successful TNFi discontinuation (area under the receiver operating characteristic curve = 0.66; 95% CI: 0.61-0.71). Results were similar when using no physician-reported flare as the criterion. TNFi-free survival was significantly different for patient groups based on the number of predictors present, ranging from 21.4% of patients with no predictor present to 66.7% of patients with all three predictors present. Conclusion: Patients using an anti-TNF monoclonal antibody, with shorter disease duration and low or moderate baseline MBDA score are most likely to achieve prolonged disease control after TNFi discontinuation.
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Keywords: Low disease activity, Predictors, Remission, Rheumatoid arthritis, TNFi discontinuation, Rheumatology
ISSN: 2520-1026
Publisher: BioMed Central Ltd.
Note: Funding Information: The POET study was funded by the Netherlands Organization for Health Research and Development (ZonMw), project number 152041002. ZonMw had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. Crescendo Bioscience funded the shipping of serum samples to its laboratory and the generation of biomarker data, but did not have any role in the study design, data collection or decision to publish the manuscript. Publisher Copyright: © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
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