A new study suggests patients with early rheumatoid arthritis (RA) who require biologic disease-modifying antirheumatic drugs (DMARDs) are less likely to achieve sustained remission after stopping these medications compared to those who don't need them.
Patients who need biologic disease-modifying antirheumatic drugs (DMARDs) for severe rheumatoid arthritis (RA) are less likely to achieve sustained DMARD-free remission compared to those who don't require these medications. Patients with early RA from the Leiden Early Arthritis Clinic (EAC) and the Rotterdam Early Arthritis Cohort (tREACH) trial were followed for 5 years and 3 years, respectively.
Most patients in both the EAC (86%) and tREACH (64%) cohorts had never used a biologic DMARD during the follow-up period. The primary outcome was sustained DMARD-free remission, defined as the absence of clinical synovitis after discontinuing DMARDs for at least 1 year. None of the EAC patients using a biologic DMARD achieved sustained DMARD-free remission, but 37% of those who never used the drug reached remission at 5 years (hazard ratio , 0.02). No tREACH patients using a biologic DMARD reached sustained DMARD-free remission, but 15% of those who never used the drug achieved remission at 3 years (HR, 0.03). Sustained DMARD-free remission was higher in EAC patients who were negative for anti-citrullinated protein antibody (ACPA) than in those who were ACPA-positive at 5 years (56% vs 14%). During follow-up, some patients in both the EAC (9%) and tREACH (14%) cohorts experienced late flares after more than 1 year of discontinuing DMARDs. Because both cohorts were defined during follow-up rather than at baseline, outcomes related to the use of DMARDs and remission status could have been misinterpreted. Although the study adjusted for ACPA status, other factors such as disease activity were not corrected, which could have potentially led to residual confounding. Sparse data bias was present, especially in the biologic DMARD user group, in which none of the patients reached sustained DMARD-free remission
Rheumatoid Arthritis Dmards Biologic Remission ACPA
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