De-intensifying treatment in established rheumatoid arthritis (RA): Why, how, when and in whom can DMARDs be tapered?

Best Practice and Research: Clinical Rheumatology

Volumn 29, Issue 4-5, 2015, Pages 550-565

  Fautrel, Bruno ^a,b   Den Broeder, Alfons A ^c  

^a SORBONNE UNIVERSITÉ   (France)

^b PITIÉ SALPÊTRIÈRE HOSPITAL   (France)

^c SINT MAARTENSKLINIEK   (Netherlands)

Author keywords

bDMARD; csDMARD; De escalation; Dose reduction; Remission; Rheumatoid arthritis; Spacing; Step down strategy; Treatment discontinuation; Treatment tapering

Indexed keywords

ABATACEPT; ADALIMUMAB; DISEASE MODIFYING ANTIRHEUMATIC DRUG; ETANERCEPT; INFLIXIMAB; METHOTREXATE; TOCILIZUMAB; ANTIRHEUMATIC AGENT; BIOLOGICAL FACTOR;

ARTICLE; CLINICAL DISEASE ACTIVITY INDEX; COST EFFECTIVENESS ANALYSIS; COST MINIMIZATION ANALYSIS; DAS28; DISEASE ACTIVITY; DISEASE ACTIVITY SCORE; DISEASE EXACERBATION; DRUG COST; DRUG DOSE REDUCTION; DRUG SAFETY; DRUG TREATMENT FAILURE; DRUG WITHDRAWAL; HUMAN; PATIENT MONITORING; PRACTICE GUIDELINE; PRIORITY JOURNAL; QUALITY ADJUSTED LIFE YEAR; RELAPSE; RHEUMATOID ARTHRITIS; ROUTINE ASSESSMENT OF PATIENT INDEX DATA; SIMPLIFIED DISEASE ACTIVITY INDEX; ARTHRITIS, RHEUMATOID; RECURRENT DISEASE; REMISSION;

ANTIRHEUMATIC AGENTS; ARTHRITIS, RHEUMATOID; BIOLOGICAL FACTORS; ETANERCEPT; HUMANS; RECURRENCE; REMISSION INDUCTION;

EID: 84951126751     PISSN: 15216942     EISSN: 15321770     Source Type: Journal    
DOI: 10.1016/j.berh.2015.09.006     Document Type: Review

References (78)

1. B. Saleem, S. Nizam, and P. Emery Can remission be maintained with or without further drug therapy in rheumatoid arthritis? Clinical and Experimental Rheumatology 24 6 Suppl. 43 2006 Nov S - 33-6
2. B. Combe, R. Landewe, C. Lukas, and et al. EULAR recommendations for the management of early arthritis: report of a task force of the european standing committee for international clinical studies including therapeutics (ESCISIT) Annals of the Rheumatic Diseases 66 1 2007 Jan 34 45
3. J.S. Smolen, D. Aletaha, J.W. Bijlsma, and et al. Treating rheumatoid arthritis to target: recommendations of an international task force Annals of the Rheumatic Diseases 69 4 2010 Apr 631 637
4. G.R. Burmester RA in 2011: advances in diagnosis, treatment and definition of remission Nature Reviews Rheumatology 8 2 2012 Feb 65 66
5. A.A. Den Broeder, A. van der Maas, and B.J. van den Bemt Dose de-escalation strategies and role of therapeutic drug monitoring of biologics in RA Rheumatology (Oxford) 49 10 2010 Oct 1801 1803
6. R. O'Mahony, A. Richards, C. Deighton, and et al. Withdrawal of disease-modifying antirheumatic drugs in patients with rheumatoid arthritis: a systematic review and meta-analysis Annals of the Rheumatic Diseases 69 10 2010 Oct 1823 1826
7. N. Van Herwaarden, A.A. den Broeder, W. Jacobs, and et al. Down-titration and discontinuation strategies of tumor necrosis factor-blocking agents for rheumatoid arthritis in patients with low disease activity Cochrane Database Systematic Reviews 9 2014 CD010455
8. X. Puéchal, and L. Guillevin Therapeutic immunomodulation in systemic vasculitis: taking stock Joint Bone Spine 80 4 2013 Jul 374 379
9. G.S. Hazlewood, C. Metzler, G.A. Tomlinson, and et al. Non-biologic remission maintenance therapy in adult patients with ANCA-associated vasculitis: a systematic review and network meta-analysis Joint Bone Spine 81 4 2014 Jul 337 341
10. A.-B. Aga, E. Lie, T. Uhlig, and et al. Time trends in disease activity, response and remission rates in rheumatoid arthritis during the past decade: results from the NOR-DMARD study 2000-2010 Annals of the Rheumatic Diseases 74 2 2015 Feb 1 381 388
11. N.B. Klarenbeek, S.M. van der Kooij, M. Guler-Yuksel, and et al. Discontinuing treatment in patients with rheumatoid arthritis in sustained clinical remission: exploratory analyses from the BeSt study Annals of the Rheumatic Diseases [Internet] 2010 Nov 10 Available from http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list-uids=21068104
12. J.A.B. Van Nies, R. Tsonaka, C. Gaujoux-Viala, and et al. Evaluating relationships between symptom duration and persistence of rheumatoid arthritis: does a window of opportunity exist? Results on the Leiden Early Arthritis Clinic and ESPOIR cohorts Annals of the Rheumatic Diseases 74 5 2015 May 806 812
13. J. Listing, K. Gerhold, and A. Zink The risk of infections associated with rheumatoid arthritis, with its comorbidity and treatment Rheumatology (Oxford) 52 1 2012 Jan 53 61
14. J.A. Singh, C. Cameron, S. Noorbaloochi, and et al. Risk of serious infection in biological treatment of patients with rheumatoid arthritis: a systematic review and meta-analysis Lancet 386 9990 2015 Jul 18 258 265
15. J.S. Smolen, R. Landewe, F.C. Breedveld, and et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update Annals of the Rheumatic Diseases 73 3 2014 Mar 492 509
16. R.F. Van Vollenhoven How to dose infliximab in rheumatoid arthritis: new data on a serious issue Annals of the Rheumatic Diseases 68 8 2009 Aug 1237 1239
17. L.D. Hughes, J. Done, and A.A. Young 5 item version of the compliance Questionnaire for Rheumatology (CQR5) successfully identifies low adherence to DMARDs BioMedCentral Musculoskeletal Disorders 14 1 2013 286
18. C.G. Grijalva, C.P. Chung, P.G. Arbogast, and et al. Assessment of adherence to and persistence on disease-modifying antirheumatic drugs (DMARDs) in patients with rheumatoid arthritis Medical Care 45 10 Supl 2 2007 Oct S66 S76
19. X. Mariette, M. Matucci-Cerinic, K. Pavelka, and et al. Malignancies associated with tumour necrosis factor inhibitors in registries and prospective observational studies: a systematic review and meta-analysis Annals of the Rheumatic Diseases 70 11 2011 Nov 1895 1904
20. X. Mariette, A.V. Reynolds, and P. Emery Updated meta-analysis of non-melanoma skin cancer rates reported from prospective observational studies in patients treated with tumour necrosis factor inhibitors Annals of the Rheumatic Diseases 71 12 2012 Dec e2
21. J. Listing, A. Strangfeld, S. Kary, and et al. Infections in patients with rheumatoid arthritis treated with biologic agents Arthritis and Rheumatism 52 11 2005 Nov 3403 3412
22. T. Bongartz, A.J. Sutton, M.J. Sweeting, and et al. Anti-TNF antibody therapy in rheumatoid arthritis and the risk of serious infections and malignancies: systematic review and meta-analysis of rare harmful effects in randomized controlled trials Journal of the American Medical Association 295 19 2006 May 17 2275 2285
23. K. Pavelka, K. Jarosova, D. Suchy, and et al. Increasing the infliximab dose in rheumatoid arthritis patients: a randomised, double blind study failed to confirm its efficacy Annals of the Rheumatic Diseases 68 8 2009 Aug 1285 1289
24. I. Nestorov Clinical pharmacokinetics of TNF antagonists: how do they differ? Seminars in Arthritis and Rheumatism 34 5 Suppl1 2005 Apr 12 18
25. B. Fautrel, S.M. Verstappen, and A. Boonen Rheumatoid arthritis: economic consequences and potential benefits Best Practice Research Clinical Rheumatology 25 4 2011 Aug 607 624
26. D.A. Hughes, A. Bagust, A. Haycox, and et al. The impact of non-compliance on the cost-effectiveness of pharmaceuticals: a review of the literature Health Economics 10 7 2001 Oct 601 615
27. B. Huggett Public biotech 2012-the numbers Nature Biotechnology 31 8 2013 Aug 697 703
28. O. Brocq, E. Millasseau, C. Albert, and et al. Effect of discontinuing TNF alpha antagonist therapy in patients with remission of rheumatoid arthritis Joint Bone Spine 76 4 2009 Jul 350 355
29. Y. Tanaka, T. Takeuchi, T. Mimori, and et al. Discontinuation of infliximab after attaining low disease activity in patients with rheumatoid arthritis: RRR (remission induction by Remicade in RA) study Annals of the Rheumatic Diseases 69 7 2010 Jul 1286 1291
30. Y. Tanaka, S. Hirata, S. Kubo, and et al. Discontinuation of adalimumab after achieving remission in patients with established rheumatoid arthritis: 1-year outcome of the HONOR study Annals of the Rheumatic Diseases [Internet] 2013 Nov 28 Available from http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list-uids=24288014
31. T. Takeuchi, T. Matsubara, S. Ohta, and et al. Abatacept biologic-free remission study in established rheumatoid arthritis patients. ORION study Arthritis and Rheumatism 64 10 2012 S552
32. N. Nishimoto, K. Amano, Y. Hirabayashi, and et al. Drug free REmission/low disease activity after cessation of tocilizumab (Actemra) Monotherapy (DREAM) study Modern Rheumatology 24 1 2014 Jan 17 25
33. L. Aguilar-Lozano, J.D. Castillo-Ortiz, C. Vargas-Serafin, and et al. Sustained clinical remission and rate of relapse after tocilizumab withdrawal in patients with rheumatoid arthritis Journal of Rheumatology 40 7 2013 Jul 1069 1073
34. P.C. Gotzsche, M. Hansen, M. Stoltenberg, and et al. Randomized, placebo controlled trial of withdrawal of slow-acting antirheumatic drugs and of observer bias in rheumatoid arthritis Scandinavian Journal of Rheumatology 25 4 1996 194 199
35. S. Ten Wolde, F.C. Breedveld, J. Hermans, and et al. Randomised placebo-controlled study of stopping second-line drugs in rheumatoid arthritis Lancet 347 8998 1996 Feb 10 347 352
36. K. Chatzidionysiou, C. Turesson, A. Teleman, and et al. A multicenter, randomized, controlled, open-label pilot study of the feasibility of discontinuation of adalimumab in rheumatoid arthritis patients in stable clinical remission Arthritis and Rheumatism 64 10 2012 S336
37. J.S. Smolen, P. Nash, P. Durez, and et al. Maintenance, reduction, or withdrawal of etanercept after treatment with etanercept and methotrexate in patients with moderate rheumatoid arthritis (PRESERVE): a randomised controlled trial Lancet [Internet] 2013 Jan 16 Available from http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list-uids=23332236
38. R.F. Van Vollenhoven, M. Ostergaard, M. Leirisalo-Repo, and et al. Full dose, reduced dose or discontinuation of etanercept in rheumatoid arthritis Annals of the Rheumatic Diseases 2015 Apr 14 annrheumdis-2014-205726. [Epub ahead of print]
39. N. Van Herwaarden, S. Herfkens-Hol, A. van der Maas, and et al. Dose reduction of tocilizumab in rheumatoid arthritis patients with low disease activity Clinical and Experimental Rheumatology 32 3 2014 Jun 390 394
40. T.W.J. Huizinga, P.G. Conaghan, E. Martin-Mola, and et al. Clinical and radiographic outcomes at 2 years and the effect of tocilizumab discontinuation following sustained remission in the second and third year of the ACT-RAY study Annals of the Rheumatic Diseases 74 1 2015 Jan 1 35 43
41. T. Takeuchi, T. Matsubara, S. Ohta, and et al. Biologic-free remission of established rheumatoid arthritis after discontinuation of abatacept: a prospective, multicentre, observational study in Japan Rheumatology (Oxford) 54 4 2015 Apr 683 691
42. N. Nishimoto, K. Amano, Y. Hirabayashi, and et al. Retreatment efficacy and safety of tocilizumab in patients with rheumatoid arthritis in recurrence (RESTORE) study Modern Rheumatology 24 1 2014 Jan 26 32
43. P.M. Welsing, R.B. Landewe, P.L. van Riel, and et al. The relationship between disease activity and radiologic progression in patients with rheumatoid arthritis: a longitudinal analysis Arthritis and Rheumatism 50 7 2004 Jul 2082 2093
44. J.M. Berthelot, A. Blanchais, T. Marhadour, and et al. Fluctuations in disease activity scores for inflammatory joint disease in clinical practice: do we need a solution? Joint Bone Spine 76 2 2009 Mar 126 128
45. C.O. Bingham 3rd, R. Alten, S.J. Bartlett, and et al. Identifying preliminary domains to detect and measure rheumatoid arthritis flares: report of the OMERACT 10 RA Flare Workshop Journal of Rheumatology 38 8 2011 Aug 1751 1758
46. S.J. Bartlett, S. Hewlett, C.O. Bingham 3rd, and et al. Identifying core domains to assess flare in rheumatoid arthritis: an OMERACT international patient and provider combined Delphi consensus Annals of the Rheumatic Diseases 71 11 2012 Nov 1855 1860
47. J.-M. Berthelot, M. De Bandt, J. Morel, and et al. A tool to identify recent or present rheumatoid arthritis flare from both patient and physician perspectives: the "FLARE" instrument Annals of the Rheumatic Diseases 71 7 2012 Jul 1110 1116
48. C. Gaujoux-Viala, J. Nam, S. Ramiro, and et al. Efficacy of conventional synthetic disease-modifying antirheumatic drugs, glucocorticoids and tofacitinib: a systematic literature review informing the 2013 update of the EULAR recommendations for management of rheumatoid arthritis Annals of the Rheumatic Diseases 73 3 2014 Mar 510 515
49. J.L. Nam, S. Ramiro, C. Gaujoux-Viala, and et al. Efficacy of biological disease-modifying antirheumatic drugs: a systematic literature review informing the 2013 update of the EULAR recommendations for the management of rheumatoid arthritis Annals of the Rheumatic Diseases 73 3 2014 Mar 516 528
50. M.A. Lopez-Olivo, J.H. Tayar, J.A. Martinez-Lopez, and et al. Risk of malignancies in patients with rheumatoid arthritis treated with biologic therapy: a meta-analysis Journal of the American Medical Association 308 9 2012 Sep 5 898 908
51. M. De Bandt, B. Fautrel, J.F. Maillefert, and et al. Determining a low disease activity threshold for decision to maintain disease-modifying antirheumatic drug treatment unchanged in rheumatoid arthritis patients Arthritis Research and Therapy 11 5 2009
52. A. Van der Maas, W. Kievit, B.J. van den Bemt, and et al. Down-titration and discontinuation of infliximab in rheumatoid arthritis patients with stable low disease activity and stable treatment: an observational cohort study Annals of the Rheumatic Diseases 71 11 2012 Nov 1849 1854
53. B. Fautrel, T. Pham, T. Alfaiate, and et al. Step-down strategy of spacing TNF-blocker injections for established rheumatoid arthritis in remission: results of the multicentre non-inferiority randomised open-label controlled trial (STRASS Spacing TNF-blocker Inject Rheumatoid ArthritiS Study) Annals of the Rheumatic Diseases 2015 Jun 23 annrheumdis-2014-206696
54. N. Van Herwaarden, A. van der Maas, M.J.M. Minten, and et al. Disease activity guided dose reduction and withdrawal of adalimumab or etanercept compared with usual care in rheumatoid arthritis: open label, randomised controlled, non-inferiority trial British Medical Journal 350 apr09 23 2015 Apr 9 h1389
55. J. Haschka, M. Englbrecht, A.J. Hueber, and et al. Relapse rates in patients with rheumatoid arthritis in stable remission tapering or stopping antirheumatic therapy: interim results from the prospective randomised controlled RETRO study Annals of the Rheumatic Diseases [Internet] 2015 Feb 6 [cited 2015 Jun 29]; Available from http://ard.bmj.com/cgi/doi/10.1136/annrheumdis-2014-206439
56. C. Gaujoux-Viala, L. Gossec, A. Cantagrel, and et al. Recommendations of the French society for Rheumatology for managing rheumatoid arthritis Joint Bone Spine 81 4 2014 Jul 287 297
57. N. Duru, M.C. van der Goes, J.W.G. Jacobs, and et al. EULAR evidence-based and consensus-based recommendations on the management of medium to high-dose glucocorticoid therapy in rheumatic diseases Annals of the Rheumatic Diseases 72 12 2013 Dec 1905 1913
58. A. Ruyssen-Witrand, B. Fautrel, A. Saraux, and et al. Infections induced by low-dose corticosteroids in rheumatoid arthritis: a systematic literature review Joint Bone Spine 77 3 2010 May 246 251
59. A. Ruyssen-Witrand, B. Fautrel, A. Saraux, and et al. Cardiovascular risk induced by low-dose corticosteroids in rheumatoid arthritis: a systematic literature review Joint Bone Spine 78 1 2011 Jan
60. V.P. Bykerk, and E.M. Massarotti The new ACR/EULAR remission criteria: rationale for developing new criteria for remission Rheumatology (Oxford) 51 Suppl. 6 2012 Dec vi16-20
61. J.A. Singh, D.E. Furst, A. Bharat, and et al. 2012 update of the 2008 American college of Rheumatology recommendations for the use of disease-modifying antirheumatic drugs and biologic agents in the treatment of rheumatoid arthritis Arthritis Care and Research 64 5 2012 May 625 639
62. D.T. Felson, J.S. Smolen, G. Wells, and et al. American college of Rheumatology/European League against Rheumatism provisional definition of remission in rheumatoid arthritis for clinical trials Annals of the Rheumatic Diseases 70 3 2011 Mar 404 413
63. V.P. Bykerk, E.C. Keystone, B. Kuriya, and et al. Achieving remission in clinical practice: lessons from clinical trial data Clinical and Experimental Rheumatology 31 4 2013 Aug 621 632
64. M. Vermeer, H.H. Kuper, A.E. van der Bijl, and et al. The provisional ACR/EULAR definition of remission in RA: a comment on the patient global assessment criterion Rheumatology (Oxford) 51 6 2012 Jun 1076 1080
65. K. Thiele, D. Huscher, S. Bischoff, and et al. Performance of the 2011 ACR/EULAR preliminary remission criteria compared with DAS28 remission in unselected patients with rheumatoid arthritis Annals of the Rheumatic Diseases 72 7 2013 Jul 1194 1199
66. L. Gossec, C. Gaujoux-Viala, and A.C. Rat Are patient global and fatigue predictive of structural damage outcomes 3 years later in early arthritis patients in remission? Result from the French ESPOIR cohort Annals of the Rheumatic Diseases 2012 S53
67. M.D. Mjaavatten, A.J. Haugen, and H.N. Nygaard The role of patient global disease activity score in the definition of ACR/EULAR remission in very early RA. Results from the NOR-VEAC study Annals of the Rheumatic Diseases 72 Suppl. 3 2013 S565
68. V. Foltz, F. Gandjbakhch, F. Etchepare, and et al. Power Doppler ultrasound, but not low-field magnetic resonance imaging, predicts relapse and radiographic disease progression in rheumatoid arthritis patients with low levels of disease activity Arthritis and Rheumatism 64 1 2012 Jan
69. A.K. Brown, M.A. Quinn, Z. Karim, and et al. Presence of significant synovitis in rheumatoid arthritis patients with disease-modifying antirheumatic drug-induced clinical remission: evidence from an imaging study may explain structural progression Arthritis and Rheumatism 54 12 2006 Dec 3761 3773
70. F. Gandjbakhch, V. Foltz, A. Mallet, and et al. Bone marrow oedema predicts structural progression in a 1-year follow-up of 85 patients with RA in remission or with low disease activity with low-field MRI Annals of the Rheumatic Diseases 70 12 2011 Dec 2159 2162
71. J.L. Marks, C.R. Holroyd, B.D. Dimitrov, and et al. Does combined clinical and ultrasound assessment Allow selection of individuals with rheumatoid arthritis for sustained reduction of anti-tumor necrosis factor therapy?: clinical and Musculoskeletal US-guided anti-TNF reduction in RA Arthritis Care and Research 67 6 2015 May 746 753
72. E.A. Haavardsholm, E. Lie, and S. Lillegraven Should modern imaging be part of remission criteria in rheumatoid arthritis? Best Practice Research CLinical Rheumatology 26 6 2012 Dec 767 785
73. Vanier A, Tubach F, Alfaiate T, et al. Step-down strategy of spacing TNF-blocker injections for established rheumatoid arthritis in remission: a cost-utility analysis based on the STRASS trial data. Annals of the Rheumatic Diseases. annrheumdis - 2015 - eular.4473.
74. C.O. Bingham 3rd, C. Pohl, T.G. Woodworth, and et al. Developing a standardized definition for disease "flare" in rheumatoid arthritis (OMERACT 9 special interest group) Journal of Rheumatology 36 10 2009 Oct 2335 2341
75. B. Fautrel A tool to identify past or present rheumatoid arthritis flare from both patient and physician perspective Annals of the Rheumatic Diseases 73 Suppl2 2014 38
76. V.P. Bykerk, E. Lie, S.J. Bartlett, and et al. Establishing a core domain set to measure rheumatoid arthritis flares: report of the OMERACT 11 RA flare Workshop Journal of Rheumatology 41 4 2014 Apr 799 809
77. P.A. Van Schouwenburg, T. Rispens, and G.J. Wolbink Immunogenicity of anti-TNF biologic therapies for rheumatoid arthritis Nature Reviews Rheumatology 9 3 2013 Mar 164 172
78. S. Hirata, K. Saito, S. Kubo, and et al. Discontinuation of adalimumab after attaining disease activity score 28-erythrocyte sedimentation rate remission in patients with rheumatoid arthritis (HONOR study): an observational study Arthritis Research and Therapy 15 5 2013 R135