Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Predictors of Successful Cessation of TNF Blockers in Patients with RA.

van den Broek4,  M., Klarenbeek5,  N. B., Dirven5,  L., Schouffoer1,  A. A., Hulsmans2,  H. M. J., Kerstens3,  P. J. S. M, Huizinga5,  T. W. J.

Groene Hart Hospital, Gouda, The Netherlands
Haga Hospital, The Hague, The Netherlands
Jan van Breemen Instituut, Amsterdam, The Netherlands
LUMC, Leiden, The Netherlands
LUMC, Leiden, The Netherlands
VU Medical Centre, Amsterdam, The Netherlands

Objective:

To observe disease activity after cessation of infliximab (IFX) and to identify predictors of persistent low disease activity.

Methods:

In the BeSt study, 120 patients with recent onset RA were treated with initial methotrexate (MTX)+IFX combination therapy, and 109 other patients started MTX+IFX after failing (DAS>2.4) on 3 previous treatment steps. If DAS remained <= 2.4 for at least 6 months, IFX was tapered and finally stopped. In these patients, possible predictors for a rise in DAS > 2.4, resulting in reintroduction of IFX were examined using Cox regression analysis.

Results:

IFX was discontinued in 76/120 patients from the initial and 27/109 from the delayed treatment group. Median DAS at time of discontinuation was 1.39 (IQR 0.84–1.70). Over a median period of 81 months (range 16–97) follow up, 54% of patients had a persistent DAS <= 2.4. In 47 patients, IFX was reintroduced after a median duration of 14 (IQR 3–44) months. After a median duration of 3 months, 85% of these patients, 25/31 from the initial and 15/16 from the delayed IFX treatment group, again had a DAS <= 2.4. Two (4%) patients did not achieve a DAS <= 2.4 after reintroduction of IFX, 3 again stopped IFX because of adverse events and 2 at patient's request.

Smoking, IFX treatment duration, physician's assessment of disease activity (VAS) and yearly damage progression were predictors of reintroduction of IFX (p<0.01). Shared epitope (SE), erosion score and treatment group showed a trend (p= 0.01). Separate analyses for both treatment groups showed similar effect sizes, with the exception of smoking in the delayed treatment group. In the multivariable model, which included treatment group, smoking (Hazard rate 2.17, 95% CI 1.11–4.26), treatment duration >=18 months (HR 2.28, 95% CI 1.01–5.12) and SE (HR 3.41, 95% CI 1.19–9.81) were independently associated with reintroduction of IFX after cessation.

Conclusion:

IFX could be discontinued successfully in more than half of patients. The majority of patients who did have a disease flare quickly regained low disease activity after reintroduction of IFX. Smoking, positive shared epitope status and long IFX treatment duration (>=18 months) were independent predictors of reintroduction of IFX after cessation.

Figure: Kaplan Meier curves depicting reintroduction of IFX over time per risk factor.

To cite this abstract, please use the following information:
van den Broek, M., Klarenbeek, N. B., Dirven, L., Schouffoer, A. A., Hulsmans, H. M. J., Kerstens, P. J. S. M, et al; Predictors of Successful Cessation of TNF Blockers in Patients with RA. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :328
DOI: 10.1002/art.28097

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