medwireNews: Findings from a systematic review and meta-analysis suggest that nearly half of patients with rheumatoid arthritis (RA) in remission experience disease relapse after elective discontinuation of tumor necrosis factor (TNF) inhibitors.
Although TNF inhibitor withdrawal is justified in some individuals with RA, at present “there is a lack of sufficient data to guide the decision,” say Arduino Mangoni (Flinders University and Flinders Medical Centre, Adelaide, South Australia) and study co-authors.
The meta-analysis included 1264 participants from 16 studies – seven randomized controlled trials, seven prospective observational studies and two retrospective investigations with follow-up ranging from 6 to 15 months – and demonstrated a pooled relapse rate after elective TNF inhibitor discontinuation of 47%. With the exception of one trial, the researchers note that “all identified studies were considered as having a high methodological quality.”
Mangoni and team write in BMC Rheumatology that their findings “provide much needed information regarding the magnitude of the overall risk of relapse in RA patients” following TNF inhibitor withdrawal.
They conclude: “Further studies are required to identify whether specific patient characteristics, [TNF] inhibitors discontinued, or concomitant DMARDs independently predict the risk of relapse in this patient group.”
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