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Discontinuing DMARDs in Well-Controlled Rheumatoid Arthritis

Withdrawal of conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) may be possible in some patients with rheumatoid arthritis (RA), according to the authors of a research letter. “For patients with RA in sustained remission while receiving half-dose csDMARD treatment, continuation of a csDMARD half-dose was not found to be superior to withdrawal regarding disease flare risk,” conclude the investigators. “Although a numerically higher number of flares was observed in the discontinuation group, most patients achieved drug-free remission for 1 year or longer. “

The data come from the open-label portion of the ARCTIC REWIND study of adults (aged 18-80 years) with RA. “Of 78 patients randomized to half-dose therapy in study period 1, 56 were eligible for the current study,” the researchers report. “Baseline characteristics were mostly well balanced. A flare within 12 months was experienced by 10 of 26 patients (38.5%) discontinuing csDMARD, compared with 5 of 30 (16.7%) continuing a half-dose (risk difference, 21.5% [95% CI, −3.4% to 49.7%]). Comparable results were found in the per-protocol population and methotrexate monotherapy users. Median time to flare among those with flare was 179 (IQR, 99-245) days in the discontinuation group and 133 (IQR, 126-217) days in the half-dose group.

“At the first visit after flare, 8 of 10 patients (80.0% [95% CI, 44.4%-97.5%]) in the discontinuation group and 2 of 3 (66.7% [95% CI, 9.5%-99.2%]) in the half-dose group regained [Disease Activity Score] remission. Radiographic joint damage progression was absent in 84.0% of patients who discontinued therapy and 69.0% of those who continued half-dose therapy (risk difference, 13.9% [95% CI, −10.6% to 38.3%]). Total adverse events numbered 22 in the discontinuation group and 26 in the half-dose group, including 1 serious adverse event (infection).”

Source: JAMA