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
Authors' conclusion
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.
Study context
- Population
- Patients with rheumatoid arthritis (RA) in remission/LDA who discontinued tumor necrosis factor inhibitors (TNFi); studies published 2005 to May 202222 induction-withdrawal and 22 maintenance studies
- Comparison
- TNFi discontinuation after induction treatment vs after maintenance treatment
- Outcome
- Prevalence of sustained remission/LDA after TNFi discontinuation
- Follow-up
- 37-52 weeks after discontinuation
Methodological detailsscoping review of predictors, pooled analyses
- Scoping review of predictors
- Pooled analyses
Pooled result
As reported in the abstract
Sustained remission/LDA after TNFi discontinuation (pooled)
| Group | Value | DAS28 < 3.2 (9 studies) | DAS28 < 2.6 (9 studies) | SDAI ≤ 3.3 (4 studies) | DAS28 < 3.2 (10 studies) | DAS28 < 2.6 (6 studies) |
|---|---|---|---|---|---|---|
| Induction-withdrawal | 58% (95% CI 45–70) | 58% | 52% (95% CI 35, 69) | 40% (95% CI 18, 64) | ||
| Maintenance treatment discontinuation | 48% (95% CI 38–59) | 48% | 47% (95% CI 33, 62) |
Value
Induction-withdrawal58% (95% CI 45–70)
Maintenance treatment discontinuation48% (95% CI 38–59)
DAS28 < 3.2 (9 studies)
Induction-withdrawal58%
Maintenance treatment discontinuation— not stated in the abstract
DAS28 < 2.6 (9 studies)
Induction-withdrawal52% (95% CI 35, 69)
Maintenance treatment discontinuation— not stated in the abstract
SDAI ≤ 3.3 (4 studies)
Induction-withdrawal40% (95% CI 18, 64)
Maintenance treatment discontinuation— not stated in the abstract
DAS28 < 3.2 (10 studies)
Induction-withdrawal— not stated in the abstract
Maintenance treatment discontinuation48%
DAS28 < 2.6 (6 studies)
Induction-withdrawal— not stated in the abstract
Maintenance treatment discontinuation47% (95% CI 33, 62)
Further pooled results
Maintained remission among patients who continued TNFi (induction-withdrawal studies)
- Maintained remission
- 62 to 85%
Predictors of successful discontinuation (scoping review)
- Longer duration of RA most consistently associated with less successful discontinuation, in both treatment scenarios
- Data on predictors in induction-withdrawal studies were limited
Original publication
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. Arthritis Res Ther. Published 20 November 2023. doi:10.
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