29 Mar Rheumatoid Arthritis: After DMARD Therapy, Some Patients May Remain Drug Free

MedicalResearch.com Interview with:

Dr. Lillegraven

Siri Lillegraven MD MPH PhD
Vice director, REMEDY Center for treatment of Rheumatic and Musculoskeletal Diseases
Leader, Unit for Clinical Research, Diakonhjemmet Hospital
Associate professor, Institute of Health and Society, Faculty of Medicine
University of Oslo

MedicalResearch.com: What is the background for this study?

Response: Rheumatoid arthritis, or RA, is a chronic disease, with joint inflammation as the primary manifestation. Due to advances in RA therapy and care, an increasing number of patients achieve sustained remission without joint damage progression and functional loss. For these patients, dose-reduction of disease modifying anti-rheumatic drugs (DMARDs), or complete withdrawal of therapy could be favorable due to potential reductions in adverse events, burden of taking medication, and healthcare costs. Current treatment recommendations suggest that tapering of conventional synthetic DMARDs could be considered in patients in sustained remission, but there is a lack of data to guide treatment decisions.

MedicalResearch.com: What are the main findings?

Response:  In the study, we assessed RA patients in sustained remission for at least two years, who had already successfully tapered conventional synthetic DMARDs to half-dose. These patients were randomized to either continued half-dose therapy, or withdrawal of csDMARDs.

The results show that in this population, a majority of patients remained flare-free for at least a year after csDMARD discontinuation. These findings highlight a potential for drug-free remission in a subgroup of RA patients, and the results provide a basis for shared decision making between patient and rheumatologist.

We know that tapering of medication is something that many patients are wondering about, and thus think these data are clinically relevant. 

MedicalResearch.com: What should readers take away from your report?

Response: One of the main take home messages is that drug free remission might be a realistic treatment target for a few of the patients with RA treated according to modern principles.

MedicalResearch.com: What recommendations do you have for future research as a results of this study?

Response: We think that it will be interesting to examine the long-term effects of DMARD tapering and withdrawal, with regards to drug free remission, joint damage and achievement of stable remission over time. Additionally, identification of predictors for disease flare is important to further personalize treatment,

MedicalResearch.com: Is there anything else you would like to add?

Response: These results should provide a basis for shared decision making, as patients might have very different preferences.

I have no relevant disclosures.

Citation:

Lillegraven S, Paulshus Sundlisæter N, Aga A, et al. Discontinuation of Conventional Synthetic Disease-Modifying Antirheumatic Drugs in Patients With Rheumatoid Arthritis and Excellent Disease Control. JAMA. 2023;329(12):1024–1026. doi:10.1001/jama.2023.0492

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Last Updated on March 29, 2023 by Marie Benz