Safely Discontinuing DMARD Treatment in Patients with Rheumatoid Arthritis

Once patients with rheumatoid arthritis (RA) achieve remission, they can safety discontinue treatment with disease-modifying anti-rheumatic drugs (DMARDs), according to research published in the Annals of Rheumatic Diseases.

Researchers from various universities and hospitals in Germany studied 101 patients to prospectively analyze the risk for disease relapses in patients with RA in sustained remission, either continuing, tapering, or stopping DMARDs. The participants were recruited from an ongoing phase 3 trial evaluating the reduction of therapy in patients with RA. Patients with a disease activity score (DAS) of 28 < 2.6 for at least 6 months were randomized into 1 of 3 arms of the study: either continuing DMARDs, tapering DMARDs by 50 percent, or stopping DMARDs after 6 months of tapering. The patients were followed up with after achieving sustained remission during the 12 month trial period.

The first 101 patients who completed the study were included in the analysis of the results. At the baseline measurements, all patients fulfilled DAS28 remission requirements and 70 percent were considered in remission by professional society guidelines. Overall, 82.2 percent of the participants received methotrexate, 40.6 percent biological DMARDs, and 9.9 percent other DMARDs. There were two thirds of patients who remained in remission for 12 months, but the other third relapsed.

The incidence of relapses was associated with which arm of the study the patients were enrolled in: methotrexate 15.8 percent; biological DMARDs 38.9 percent; other DMARDs 51.9 percent. The researchers noted that predictors for relapse were anticitrullinated protein antibodies (ACTA) positivity as well as treatment reduction, when compared to continuation.

“This randomized controlled study, testing three different treatment strategies in patients with RA in sustained remission, demonstrated that more than half of the patients maintain in remission after tapering or stopping conventional and biological DMARD treatment,” the authors explained in their paper. “Relapses occurred particularly in the first 6 months after treatment reduction and were associated with the presence of ACPA.”