Prevalence and predictors of sustained remission/low disease activity after discontinuation of induction or maintenance treatment with tumor necrosis factor inhibitors in rheumatoid arthritis: a systematic and scoping review.

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Citation: Arthritis Research & Therapy. 25(1):222, 2023 Nov 20.PMID: 37986101Institution: MedStar Washington Hospital CenterDepartment: RheumatologyForm of publication: Journal ArticleMedline article type(s): Journal Article | Systematic ReviewSubject headings: *Antirheumatic Agents | *Arthritis, Rheumatoid | Antirheumatic Agents/tu [Therapeutic Use] | Arthritis, Rheumatoid/dt [Drug Therapy] | Arthritis, Rheumatoid/ep [Epidemiology] | Arthritis, Rheumatoid/pa [Pathology] | Humans | Prevalence | Remission Induction | Treatment Outcome | Tumor Necrosis Factor Inhibitors/tu [Therapeutic Use] | Tumor Necrosis Factor-alphaYear: 2023ISSN:
  • 1478-6354
Name of journal: Arthritis research & therapyAbstract: BACKGROUND: To determine the prevalence of sustained remission/low disease activity (LDA) in patients with rheumatoid arthritis (RA) after discontinuation of tumor necrosis factor inhibitors (TNFi), separately in induction treatment and maintenance treatment studies, and to identify predictors of successful discontinuation.CONCLUSIONS: Approximately one-half of patients with RA remain in remission/LDA for up to 1 year after TNFi discontinuation, with slightly higher proportions in induction-withdrawal settings than with maintenance treatment discontinuation. Copyright © 2023. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.METHODS: We performed a systematic literature review of studies published from 2005 to May 2022 that reported outcomes after TNFi discontinuation among patients in remission/LDA. We computed prevalences of successful discontinuation by induction or maintenance treatment, remission criterion, and follow-up time. We performed a scoping review of predictors of successful discontinuation.RESULTS: Twenty-two induction-withdrawal studies were identified. In pooled analyses, 58% (95% confidence interval (CI) 45, 70) had DAS28 < 3.2 (9 studies), 52% (95% CI 35, 69) had DAS28 < 2.6 (9 studies), and 40% (95% CI 18, 64) had SDAI <= 3.3 (4 studies) at 37-52 weeks after discontinuation. Among patients who continued TNFi, 62 to 85% maintained remission. Twenty-two studies of maintenance treatment discontinuation were also identified. At 37-52 weeks after TNFi discontinuation, 48% (95% CI 38, 59) had DAS28 < 3.2 (10 studies), and 47% (95% CI 33, 62) had DAS28 < 2.6 (6 studies). Heterogeneity among studies was high. Data on predictors in induction-withdrawal studies were limited. In both treatment scenarios, longer duration of RA was most consistently associated with less successful discontinuation.All authors: Ward MM, Madanchi N, Yazdanyar A, Shah NR, Constantinescu FFiscal year: FY2024Digital Object Identifier: Date added to catalog: 2024-01-16
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Journal Article MedStar Authors Catalog Article 37986101 Available 37986101

BACKGROUND: To determine the prevalence of sustained remission/low disease activity (LDA) in patients with rheumatoid arthritis (RA) after discontinuation of tumor necrosis factor inhibitors (TNFi), separately in induction treatment and maintenance treatment studies, and to identify predictors of successful discontinuation.

CONCLUSIONS: Approximately one-half of patients with RA remain in remission/LDA for up to 1 year after TNFi discontinuation, with slightly higher proportions in induction-withdrawal settings than with maintenance treatment discontinuation. Copyright © 2023. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.

METHODS: We performed a systematic literature review of studies published from 2005 to May 2022 that reported outcomes after TNFi discontinuation among patients in remission/LDA. We computed prevalences of successful discontinuation by induction or maintenance treatment, remission criterion, and follow-up time. We performed a scoping review of predictors of successful discontinuation.

RESULTS: Twenty-two induction-withdrawal studies were identified. In pooled analyses, 58% (95% confidence interval (CI) 45, 70) had DAS28 < 3.2 (9 studies), 52% (95% CI 35, 69) had DAS28 < 2.6 (9 studies), and 40% (95% CI 18, 64) had SDAI <= 3.3 (4 studies) at 37-52 weeks after discontinuation. Among patients who continued TNFi, 62 to 85% maintained remission. Twenty-two studies of maintenance treatment discontinuation were also identified. At 37-52 weeks after TNFi discontinuation, 48% (95% CI 38, 59) had DAS28 < 3.2 (10 studies), and 47% (95% CI 33, 62) had DAS28 < 2.6 (6 studies). Heterogeneity among studies was high. Data on predictors in induction-withdrawal studies were limited. In both treatment scenarios, longer duration of RA was most consistently associated with less successful discontinuation.

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