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

• Published in: Arthritis research & therapy Vol. 25; no. 1; p. 222
• Main Authors: Ward, Michael M, Madanchi, Nima, Yazdanyar, Ali, Shah, Nehal R, Constantinescu, Florina
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 20.11.2023; BioMed Central; BMC
• Subjects: Adalimumab; Antirheumatic Agents - therapeutic use; Arthritis; Arthritis, Rheumatoid - drug therapy; Arthritis, Rheumatoid - epidemiology; Arthritis, Rheumatoid - pathology; Cancer; Care and treatment; Diagnosis; Disease; Dosage and administration; Drug therapy; Humans; Induction therapy; Necrosis; Observational studies; Patient outcomes; Prevalence; Regression (Disease); Remission; Remission (Medicine); Remission Induction; Rheumatoid arthritis; Rheumatoid factor; Systematic review; Treatment Outcome; Tumor necrosis factor; Tumor necrosis factor inhibitor; Tumor necrosis factor inhibitors; Tumor Necrosis Factor Inhibitors - therapeutic use; Tumor Necrosis Factor-alpha; Tumor necrosis factor-TNF; Tumors; United States; Tumor necrosis factor inhibitor; Remission; Rheumatoid arthritis
• DOI: 10.1186/s13075-023-03199-0
• ISSN: 1478-6362; 1478-6354

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. 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. 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. 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.