CLINICAL AND RADIOGRAPHIC RESULTS OF TAPERING AND WITHDRAWING CSDMARDS VERSUS STABLE TREATMENT IN PATIENTS WITH RHEUMATOID ARTHRITIS IN REMISSION: 3-YEAR RESULTS FROM A RANDOMIZED CONTROLLED TRIAL
Authors: Kaja Eriksrud Kjørholt et al.
The aim of this trial was to compare the 3-year impact of three csDMARD treatment strategies in RA patients in sustained remission. Patients were randomized to either (1) continued stable csDMARD treatment, (2) half-dose treatment or (3) tapering to withdrawal. ARCTIC REWIND enrolled RA patients in sustained remission for ≥1 year on stable csDMARD therapy and 139 patients completed 3-years follow-up.
80 % of RA patients remained flare-free in the stable group, compared with 60 % in the half-dose group (adjusted HR (aHR) for flare 2.7), and 38 % in the tapering to withdrawal group (aHR for flare 4.3). Slightly more radiographic progression occurred in the reduced csDMARD groups.
Tapering of antirheumatic drugs to achieve drug-free remission is a potential goal for the growing group of patients with RA in remission, although the long-term effects of such strategies were unclear. The results of this study can be interpreted in different ways: Clearly, reducing or stopping csDMARDs is associated with a significantly increased risk of disease flare. Still more than 1/3 patients of patients in the withdrawal arm achieved long-term drug-free remission, suggesting that this is a realistic option for some RA patients in sustained remission. Reassuringly, there was no difference in disease activity at the end of the 3-year follow-up of the study, indicating that re-initiation of csDMARDs will allow to recover remission in most patients.