ARCTIC REWIND supports TNF inhibitor continuation in sustained RA remission
medwireNews: Withdrawal of tumor necrosis factor (TNF) inhibitors leads to a “steep increase” in flare risk among patients with rheumatoid arthritis (RA) in longstanding remission, report the ARCTIC REWIND investigators.
Therefore, “continued treatment [with TNF inhibitors] should be the preferred treatment choice,” said Siri Lillegraven (Diakonhjemmet Hospital, Norway) at the EULAR 2020 E-Congress.
The phase 4 noninferiority study included 84 RA patients who had been in remission for at least 1 year while on stable treatment with a TNF inhibitor and were randomly assigned to TNF inhibitor withdrawal – involving taking half the dose for 4 months followed by discontinuation – or to continue with a stable dose. The most commonly used TNF inhibitor in the tapering and control groups was etanercept (44% in both arms), followed by certolizumab pegol (28–37%), and the majority of patients in both groups were receiving concomitant treatment with conventional DMARDs (88–93%).
Lillegraven told delegates that 62.8% of 43 patients in the tapering group experienced a disease flare in the year following randomization, compared with just 4.9% of the 41 participants in the stable treatment arm, with a significant risk difference of 57.9%.
“These results did not support non-inferiority of the tapered treatment but stable treatment was deemed superior,” said the presenter.
She explained that TNF inhibitor treatment was reinstated in patients who experienced flares, and “most patients responded well to this,” with 86% of the 26 patients with available data being back in remission at the first assessment post-flare.
At the 1-year follow-up, there was no significant difference between the groups in disease activity score, PROMIS physical function score, or radiographic progression.
Lillegraven said that the overall rates of adverse events were comparable in the two arms over the 1-year study period, but there was a lower rate of infections in the treatment withdrawal compared with the stable TNF inhibitor group (23 vs 42%).
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