Withdrawal of TNF Inhibitors Fails in Most RA Patients

Doctors answer the question about what happens when you stop RA treatment in patients that appear stable on treatment.

by Dr. C.H. Weaver M.D. updated 6/2019

TNF inhibitors are biologic drugs that are commonly used in the treatment of rheumatoid arthritis (RA) and certain other autoimmune conditions. These drugs include Enbrel® (etanercept), Remicade® (infliximab), Humira® (adalimumab), Cimzia® (certolizumab), and Simponi® (golimumab).

Many patients wonder how long they need to remain on therapy to control symptoms of RA and whether there are negative effects that can result from stopping treatment once in a clinical remission. Doctors have performed a clinical study specifically designed to answer this question.

The 12 month POET clinical study analyzed a group of 817 RA patients who achieved remission or a low level of disease activity for at least 6 months. Patients either stopped or continued their TNFi and were directly compared. The study revealed that stopping TNFi treatment had significantly negative consequences in the negative short-term, with fewer long-term negative consequences to drug cessation.

Stopping TNFi had a significant negative short-term impact on a broad range of patient reported symptoms. In fact the study revealed that stopping TNFi treatment in patients with established RA in remission or low levels of disease activity resulted in substantially more clinical flares. Most patients who restarted TNFi treatment quickly regained remission or low disease activity.

Importantly the study did not evaluate the impact on joint erosion or other physical manifestations of RA. It's important for patients to remember that in addition to symptom relief, a main goal of treatment is to prevent irreversible joint damage.

Reference: Moghadam G, Klooster T, Vonkeman HE, et al. Impact of Stopping Tumor Necrosis Factor-inhibitors on Rheumatoid Arthritis Patients’ Burden of Disease. Arthritis Care Res (Hoboken). 2017 Jul 10. doi: 10.1002/acr.23315. [Epub ahead of print]

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