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

• Main Authors: Marjan Ghiti Moghadam, Femke B. G. Lamers-Karnebeek, Harald E. Vonkeman, Peter M. ten Klooster, Janneke Tekstra, Barbara van Schaeybroeck, Ruth Klaasen, Marieke van Onna, Hein J. Bernelot Moens, Henk Visser, Annemarie M. Schilder, Marc R. Kok, Robert B. M. Landewé, Piet L. C. M. van Riel, Mart A. F. J. van de Laar, Tim L. Jansen, on behalf of the Dutch National POET Collaboration
• Format: Article
• Language: English
• Published: BMC 2019-06-01
• Series: BMC Rheumatology
• Subjects: Rheumatoid arthritis; Remission; Low disease activity; TNFi discontinuation; Predictors
• Online Access: http://link.springer.com/article/10.1186/s41927-019-0071-x

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 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. Trial registration Netherlands Trial Register NTR3112, 21 October 2011.