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ACR 2020 | Daily Highlights
Withdrawal of Etanercept and MTX
MAINTENANCE OF REMISSION AFTER WITHDRAWAL OF ETANERCEPT OR METHOTREXATE IN PATIENTS WITH RHEUMATOID ARTHRITIS IN SUSTAINED REMISSION ON COMBINATION THERAPY: RESULTS FROM A RANDOMIZED, DOUBLE-BLIND, CONTROLLED TRIAL
Abstract: 0939
Authors: Jeffrey R Curtis et al.
Key content:
RA patients responding well to combination therapy of bDMARDs and concomitant methotrexate (MTX) are often tempted to reduce the burden of continuing medication. While reducing therapy has been studied previously, trials have never compared whether discontinuing the MTX or the bDMARD is most effective in retaining remission. This study compared withdrawing either MTX or etanercept (ETN) on maintaining remission in RA patients who had been in sustained, stringent remission while on Combo ETN + MTX.
253 patients in remission for at least 24 weeks, were randomized to: (1) withdrawal of ETN (MTX mono, N=101 pts); (2) withdrawal of MTX (ETN mono, N=101 pts); or (3) continue Combo (ETN+MTX, N=51). At week 24, SDAI remission was maintained by significantly more pts on ETN mono vs MTX mono (50% vs 29%; p=0.004) and by more pts on Combo vs MTX mono (53% vs 29%; P=0.006).
Relevance:
This study validates the common practice in clinic to withdraw concomitant MTX, rather than the bDMARD, in patients in stable remission. The proportion of patients who maintained remission was nearly identical with ETN mono and with the Combo ETN + MTX, suggesting that once patients have reached a sustained remission the association with MTX is no longer needed. However, one should be careful when generalizing these results to other bDMARDs, in particular to monoclonal antibodies, who may elicit more often anti-drug antibodies when prescribed in monotherapy. However, for patients and physicians seeking to reduce treatment burden, these data are useful when discussing therapy withdrawal in well-controlled RA patients.
Zusammenfassung und Kommentar von:
Prof. Dr. Axel Finckh
Genf
