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Tapering conventional DMARDs for rheumatoid arthritis may reduce flare-free survival compared to stable treatment.
A recent study conducted across multiple hospitals in Norway sheds light on the effectiveness of different treatment modalities for rheumatoid arthritis (RA) patients aged 18 to 80 years in sustained remission. The study enrolled 160 RA patients who were randomly assigned to one of three groups: stable conventional synthetic disease-modifying anti-rheumatic drugs (DMARDs) treatment (80 patients), half-dose conventional synthetic DMARD treatment (42 patients), or half-dose treatment followed by complete withdrawal of conventional synthetic DMARDs (38 patients).
This study compared disease flare risk over three years across three treatment strategies. The results revealed that patients receiving stable conventional synthetic DMARDs had significantly higher flare-free survival rates compared to those in the other two groups. Specifically, 80% of patients in the stable-dose group remained flare-free, while only 57% and 38% of patients in the half-dose and withdrawal groups respectively experienced flare-free survival.
Moreover, the study found that the risk of flare was notably higher in the groups where DMARD dosage was reduced or completely withdrawn compared to the stable treatment group. The risk difference of flare was 23% in the half-dose group and 40% in the withdrawal group compared to the stable-dose group.
Additionally, many patients reported adverse across all the groups, with one demise occurring in the stable-dose group. It was uncertain whether it is linked to the study medication.
Overall, while the study implies that tapering or withdrawing conventional synthetic DMARDs may not be as effective in maintaining remission compared to stable treatment, it also highlights the potential for drug-free remission in a significant subgroup of patients, Kjørholt concluded.
The Lancet Rheumatology
Effects of tapering conventional synthetic disease-modifying antirheumatic drugs to drug-free remission versus stable treatment in rheumatoid arthritis (ARCTIC REWIND): 3-year results from an open-label, randomised controlled, non-inferiority trial
Kaja E Kjørholt et al.
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