Document Detail

Patients with RA in remission on TNF blockers: when and in whom can TNF blocker therapy be stopped?
MedLine Citation:
PMID:  20421345     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: Combination therapy with methotrexate (MTX) and tumour necrosis factor (TNF) blockade has increased remission rates in patients with rheumatoid arthritis. However, there are no guidelines regarding cessation of therapy. There is a need for markers predictive of sustained remission following cessation of TNF blocker therapy.
METHODS: Patients in remission (DAS28 <2.6) treated with a TNF blocker and MTX as initial or delayed therapy were recruited. Joints were assessed for grey scale synovitis and power Doppler (PD) activity. Immunological assessment involved advanced six-colour flow cytometry.
RESULTS: Of the 47 patients recruited, 27 had received initial treatment and 20 delayed treatment with TNF blocking drugs. Two years after stopping TNF blocker therapy, the main predictor of successful cessation was timing of treatment; 59% of patients in the initial treatment group sustained remission compared with 15% in the delayed treatment group (p=0.003). Within the initial treatment group, secondary analysis showed that the only clinical predictor of successful cessation of treatment was shorter symptom duration before receiving treatment (median 5.5 months vs 9 months; p=0.008). No other clinical features were associated with successful cessation of therapy. Thirty-five per cent of patients had low PD activity but levels were not informative. Several immunological parameters were significantly associated with sustained remission including abnormal differentiation subset of T cells and regulatory T cells. Similar non-significant trends were observed in the delayed treatment group.
CONCLUSION: In patients in remission with low levels of imaging synovitis receiving combination treatment with a TNF blocker and MTX, immunological parameters and short duration of untreated symptoms were associated with successful cessation of TNF blocker therapy.
Benazir Saleem; Helen Keen; Vincent Goeb; Rekha Parmar; Sharmin Nizam; Elizabeth M A Hensor; Sarah M Churchman; Mark Quinn; Richard Wakefield; Philip G Conaghan; Frederique Ponchel; Paul Emery
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-04-26
Journal Detail:
Title:  Annals of the rheumatic diseases     Volume:  69     ISSN:  1468-2060     ISO Abbreviation:  Ann. Rheum. Dis.     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-08-11     Completed Date:  2010-09-07     Revised Date:  2014-06-03    
Medline Journal Info:
Nlm Unique ID:  0372355     Medline TA:  Ann Rheum Dis     Country:  England    
Other Details:
Languages:  eng     Pagination:  1636-42     Citation Subset:  IM    
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MeSH Terms
Antirheumatic Agents / administration & dosage*,  therapeutic use
Arthritis, Rheumatoid / complications,  drug therapy*,  immunology,  ultrasonography
CD4-Positive T-Lymphocytes / immunology
Drug Administration Schedule
Drug Therapy, Combination
Follow-Up Studies
Methotrexate / therapeutic use
Middle Aged
Remission Induction
Synovitis / etiology,  ultrasonography
T-Lymphocytes, Regulatory / immunology
Treatment Outcome
Tumor Necrosis Factor-alpha / antagonists & inhibitors*
Young Adult
Grant Support
18475//Arthritis Research UK
Reg. No./Substance:
0/Antirheumatic Agents; 0/Tumor Necrosis Factor-alpha; YL5FZ2Y5U1/Methotrexate
Erratum In:
Ann Rheum Dis. 2011 Aug;70(8):1520

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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