Predictors of biologic-free disease control in patients with rheumatoid arthritis after stopping tumor necrosis factor inhibitor treatment

BMC Rheumatology

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[1] 0000 0004 0368 8146, grid.414725.1, Department of Rheumatology, Meander Medical Centre, Amersfoort, The Netherlands;0000 0004 0396 792X, grid.413972.a, Department of Rheumatology, Albert Schweitzer Hospital, Dordrecht, The Netherlands;0000 0004 0399 8347, grid.415214.7, Department of Rheumatology, Medisch Spectrum Twente, Enschede, The Netherlands;0000 0004 0399 8953, grid.6214.1, Department of Psychology, Health & Technology, University of Twente, PO BOX 217, 7500 AE, Enschede, the Netherlands;0000 0004 0399 8953, grid.6214.1, Department of Psychology, Health & Technology, University of Twente, PO BOX 217, 7500 AE, Enschede, the Netherlands;0000 0004 0419 3743, grid.414846.b, Department of Rheumatology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands;0000 0004 0444 9382, grid.10417.33, Department of IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands;0000 0004 0444 9382, grid.10417.33, Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands;0000 0004 0460 0556, grid.416213.3, Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Rotterdam, The Netherlands;0000 0004 0477 5022, grid.416856.8, Department of Rheumatology, VieCuri Medical Center, Venlo, The Netherlands;0000 0004 0502 0983, grid.417370.6, Department of Rheumatology, Ziekenhuis Groep Twente, Hengelo, The Netherlands;0000000090126352, grid.7692.a, Department of Rheumatology, University Medical Center Utrecht, Utrecht, The Netherlands;0000000404654431, grid.5650.6, Department of Clinical Immunology and Rheumatology, Academic Medical Center, Amsterdam, The Netherlands;grid.415930.a, Department of Rheumatology, Rijnstate, Arnhem, The Netherlands;

关键词: Rheumatoid arthritis;    Remission;    Low disease activity;    TNFi discontinuation;    Predictors;   

DOI  :  10.1186/s41927-019-0071-x

来源: publisher

【 摘 要 】

BackgroundThe 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).MethodsPost-hoc analysis of 439 RA patients (67.3% rheumatoid factor positive) with longstanding RA in remission or with stable low disease 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.ResultsOne 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.ConclusionPatients 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.Trial registrationNetherlands Trial Register NTR3112, 21 October 2011.

【 授权许可】

CC BY