Intensive Intervention Can Lead to a Treatment Holiday from Biological DMARDs in Patients with Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by inflammation and joint destruction that causes significant morbidity and mortality. However, the combined use of methotrexate (MTX), a synthetic disease-modifying anti-rheumatic drug (sDMARD) and biological DMARDs (bDMARDs)...

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Main Authors:	Tanaka, Yoshiya, Hirata, Shintaro
Format:	Online
Language:	English
Published:	Springer International Publishing 2014
Online Access:	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4245498/

id	pubmed-4245498
recordtype	oai_dc
spelling	pubmed-42454982014-12-03 Intensive Intervention Can Lead to a Treatment Holiday from Biological DMARDs in Patients with Rheumatoid Arthritis Tanaka, Yoshiya Hirata, Shintaro Leading Article Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by inflammation and joint destruction that causes significant morbidity and mortality. However, the combined use of methotrexate (MTX), a synthetic disease-modifying anti-rheumatic drug (sDMARD) and biological DMARDs (bDMARDs) has revolutionized treatment of RA and clinical remission or low disease activity (LDA) are now realistic targets, achieved by a large proportion of RA patients. We are now in a position to evaluate if it is possible to maintain remission or LDA while at the same time reducing the burden of treatment on the patient and healthcare system. Data are emerging from large, well-conducted studies designed to answer this question, shedding light on which patient populations and treatment algorithms can survive treatment discontinuation or tapering with low risk of disease flare. For early RA, approximately half of early RA patients could discontinue TNF-targeted bDMARDs without clinical flare and functional impairment after obtaining clinical remission by bDMARDs with MTX. In contrast, for established RA, fewer patients sustained remission or LDA after the discontinuation of bDMARDs and “deep remission” at the discontinuation was a key factor to maintain the treatment holiday of bDMARDs. Thus, this article provides a brief outline on withdrawing or tapering bDMARDs once patients have achieved remission or LDA in RA. Springer International Publishing 2014-11-12 2014 /pmc/articles/PMC4245498/ /pubmed/25389048 http://dx.doi.org/10.1007/s40265-014-0323-4 Text en © The Author(s) 2014 Open AccessThis article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.
repository_type	Open Access Journal
institution_category	Foreign Institution
institution	US National Center for Biotechnology Information
building	NCBI PubMed
collection	Online Access
language	English
format	Online
author	Tanaka, Yoshiya Hirata, Shintaro
spellingShingle	Tanaka, Yoshiya Hirata, Shintaro Intensive Intervention Can Lead to a Treatment Holiday from Biological DMARDs in Patients with Rheumatoid Arthritis
author_facet	Tanaka, Yoshiya Hirata, Shintaro
author_sort	Tanaka, Yoshiya
title	Intensive Intervention Can Lead to a Treatment Holiday from Biological DMARDs in Patients with Rheumatoid Arthritis
title_short	Intensive Intervention Can Lead to a Treatment Holiday from Biological DMARDs in Patients with Rheumatoid Arthritis
title_full	Intensive Intervention Can Lead to a Treatment Holiday from Biological DMARDs in Patients with Rheumatoid Arthritis
title_fullStr	Intensive Intervention Can Lead to a Treatment Holiday from Biological DMARDs in Patients with Rheumatoid Arthritis
title_full_unstemmed	Intensive Intervention Can Lead to a Treatment Holiday from Biological DMARDs in Patients with Rheumatoid Arthritis
title_sort	intensive intervention can lead to a treatment holiday from biological dmards in patients with rheumatoid arthritis
description	Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by inflammation and joint destruction that causes significant morbidity and mortality. However, the combined use of methotrexate (MTX), a synthetic disease-modifying anti-rheumatic drug (sDMARD) and biological DMARDs (bDMARDs) has revolutionized treatment of RA and clinical remission or low disease activity (LDA) are now realistic targets, achieved by a large proportion of RA patients. We are now in a position to evaluate if it is possible to maintain remission or LDA while at the same time reducing the burden of treatment on the patient and healthcare system. Data are emerging from large, well-conducted studies designed to answer this question, shedding light on which patient populations and treatment algorithms can survive treatment discontinuation or tapering with low risk of disease flare. For early RA, approximately half of early RA patients could discontinue TNF-targeted bDMARDs without clinical flare and functional impairment after obtaining clinical remission by bDMARDs with MTX. In contrast, for established RA, fewer patients sustained remission or LDA after the discontinuation of bDMARDs and “deep remission” at the discontinuation was a key factor to maintain the treatment holiday of bDMARDs. Thus, this article provides a brief outline on withdrawing or tapering bDMARDs once patients have achieved remission or LDA in RA.
publisher	Springer International Publishing
publishDate	2014
url	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4245498/
_version_	1613161204691238912

Intensive Intervention Can Lead to a Treatment Holiday from Biological DMARDs in Patients with Rheumatoid Arthritis

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