A collaborative study involving several hospitals and universities in Germany recently revealed that patients with rheumatoid arthritis in sustained remission can safely discontinue the treatment with disease-modifying anti-rheumatic drugs (DMARDs). The findings were published in the journal Annals of Rheumatic Diseases and the study is entitled “Relapse rates in patients with rheumatoid arthritis in stable remission tapering or stopping anti rheumatic therapy: interim results from the prospective randomised controlled RETRO study.”
RA is an autoimmune disease that leads to chronic inflammation and pain in the joints and other parts of the body due to an overreaction of the body’s own immune system, which results in the attack of healthy tissues. Thanks to medication and more aggressive therapeutic strategies, remission of rheumatoid arthritis is becoming increasingly possible, although many people who achieve remission still experience relapses.
In this study, a prospective randomized controlled trial was conducted to determine the risk for disease relapses in RA patients in remission. In total, 101 patients who were participating on a phase 3 clinical trial to assess therapy reduction in RA were enrolled. The patients, all in remission, were randomly divided into three categories: continued treatment with disease-modifying anti-rheumatic drugs (DMARDs), reducing DMARDs by 50%, and stopping DMARDs use after reducing it for 6 months. All patients were followed for a period of 12 months. 82.2% of the patients was given methotrexate, 40.6% biological DMARDs, and 9.9% other type of DMARDs.
Researchers found that 66.3% of the patients in the cohort had sustained remission for the 12-month period of the trial, while 33.7% relapsed. The incidence of relapses was found to be linked to the patient category, where patients under continued methotrexate treatment had a relapse incidence of 15.8%, patients given 50% less DMARDs had an incidence of 38.9%, and patients who stopped DMARDs after 6 months were linked to a relapse incidence of 51.9%. The research team also found that the presence of anticitrullinated protein antibodies (ACTA) and treatment reduction were both relapse predictors.
“This randomized controlled study, testing three different treatment strategies in patients with RA in sustained remission, demonstrated that more than half of the patients maintain in remission after tapering or stopping conventional and biological DMARD treatment,” explained the research team. “Relapses occurred particularly in the first 6 months after treatment reduction and were associated with the presence of ACPA.” The team suggests that once RA patients achieve remission, they can safely discontinue DMARDs treatment.