Skip to main content
Top

19-10-2021 | Rheumatoid arthritis | News

RETRO demonstrates treatment reduction feasibility for RA in stable remission

Author: Laura Cowen

print
PRINT
insite
SEARCH

medwireNews: Approximately half of patients with rheumatoid arthritis (RA) in sustained remission could feasibly taper or stop DMARD treatment for at least 12 months without experiencing relapse, results of the phase 3 RETRO study indicate.

However, Georg Schett (Universitätsklinikum Erlangen, Germany) and co-investigators note that the risk for relapse was three to four times higher in people who tapered or stopped treatment relative to those who continued, “indicating that such approaches require tight monitoring of disease activity and, if necessary, the reintroduction of therapy, as occurred in this study.”

The multicenter RETRO trial included 282 adults (mean age 57 years, 59% women) with RA (mean duration 7.4 years) who had been in sustained remission (DAS28-ESR <2.6 units) for an average of 20.0 months. All participants were stable on treatment for at least 6 months with either one or more conventional synthetic DMARDs, or with a biologic DMARD alone or in combination with conventional synthetic DMARDs.

At baseline, they were randomly assigned to continue with their full DMARD and glucocorticoid dose for 12 months (continue group; n=93), taper to a half dose of all DMARDs and glucocorticoids for 12 months (taper group; n=93), or taper to a half dose for 6 months and then stop all treatments if there had been no relapse during tapering (stop group; n=96).

As reported in The Lancet Rheumatology, 81.2% of individuals in the continue group maintained remission without relapse at 12 months.

By comparison, the rates were 58.6% and 43.3% in the taper and stop groups, respectively, corresponding to 3.02- and 4.34-fold increased risks for relapse relative to continuing with the full treatment dose.

Further analysis revealed that female sex, longer disease duration, rheumatoid factor and anti-citrullinated protein antibody positivity, biologic use, and higher baseline DAS28 scores were each associated with an increased risk for relapse after tapering or stopping treatment.

However, the researchers note the majority of patients who relapsed regained remission after reintroduction of their original DMARD therapy. Indeed, at 12 months, the overall remission rates, when combining those with relapse-free remission and those with relapse who regained remission, were 88% in the continue group, 74% in the taper group, and 75% in the stop group.

Schett et al conclude that the results of their treatment strategy trial support “an increasingly dynamic management approach in patients with rheumatoid arthritis in stable remission.”

In an accompanying comment, Catherine Hill, from the University of Adelaide in South Australia, says that the RETRO trial “represents a randomised controlled trial that emulates a real-life setting, with results directly relevant to clinical practice.”

She adds that although “[c]ontemplation of treatment tapering or discontinuation in some patients with rheumatoid arthritis is remarkable and a measure of how far treatments have advanced,” further work is still required “to address outstanding questions on who should taper and how best to do it.”

medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2021 Springer Healthcare Ltd, part of the Springer Nature Group

Lancet Rheumatol 2021; doi:10.1016/S2665-9913(21)00220-4
Lancet Rheumatol 2021; doi:10.1016/S2665-9913(21)00271-X

print
PRINT