After discontinuing tumor necrosis factor inhibitors (TNFis), approximately 50% of patients with rheumatoid arthritis (RA) were able to sustain remission or achieve low disease activity (LDA) for up to 1 year. Notably, induction-withdrawal scenarios tended to yield slightly higher rates of discontinuation success, compared with halting maintenance treatment, according to study results published in Arthritis Research & Therapy.

Researchers conducted a systematic review to assess the frequency of sustained remission or LDA among patients with RA discontinuing TNFis. Induction-withdrawal and maintenance-treatment discontinuation studies were included in the analysis and researchers reported on key factors that contributed to successful TNFi discontinuation.

Discontinuation criteria included a Disease Activity Score-28 (DAS28) of less than 3.2, a DAS28 score of less than 2.6, and other alternative indicators.

A total of 43 studies were identified and reviewed, comprised of 22 induction-withdrawal studies and 22 maintenance TNFi discontinuation studies. A single study reported on both groups.

Among induction-withdrawal studies, pooled analyses from weeks 37 to 52 following discontinuation revealed that 58% of patients (95% CI, 45-70) achieved a DAS28 score of less than 3.8 and 52% of patients (95% CI, 35-69) achieved a score of less than 2.6 across 9 studies; 40% of patients (95%, CI 18-64) across 4 studies achieved a Simplified Disease Activity Index (SDAI) score of 3.3 or less.

Among patients who continued with TNFi treatment, 85%, 73%, and 62% maintained DAS28 scores of less than 3.8 and 2.6, and SDAI scores of 3.3 or less, respectively.

Among 10 maintenance-treatment discontinuation studies, approximately 48% of patients (95% CI, 38-59) achieved a DAS28 score of less than 3.2, while 47% of patients (95% CI, 33-62) across 6 studies achieved a DAS28 score of 2.6 or less during weeks 37 to 52 following TNFi treatment discontinuation. Additionally, 46% of patients achieved SDAI scores of 3.3 or less during this period.

More patients from the induction-withdrawal studies achieved successful discontinuation.

Successful treatment discontinuation was associated with a shorter duration of RA, lower Health Assessment Questionnaire scores, lower disease activity scores, and specific proportions of immune cells.

In both treatment scenarios, a longer history of RA consistently showed a correlation with lower rates of successful discontinuation.

This analysis was limited by the wide definitions of remission across included studies

Study authors concluded, “These results may be useful in shared decision-making with patients who are contemplating treatment de-escalation. More research is needed to identify how risks of relapse vary in patient subgroups.”