5-year remission rate after the discontinuation of adalimumab in patients with rheumatoid arthritis: Long-term follow-up results of the HONOR study

Abstract

Objectives: To determine the rate and factors associated with remission (disease activity score (DAS) 28-erythrocyte sedimentation rate (ESR) of <2.6) during a 5-year follow-up after the discontinuation of adalimumab (ADA) in patients with rheumatoid arthritis (RA). Methods: 75 patients who had been treated with ADA þ methotrexate (MTX) and maintained DAS28-ESR <2.6 for at least 6 months were enrolled. Among them, 52 patients discontinued ADA, and 46 patients completed a 5-year follow-up. Results: During the 5 years, 11 patients had DAS28-ESR <2.6. In 15 patients with DAS28-ESR <3.2, no significant changes were found in the health assessment questionnaire disability index (HAQ-DI) and modified total Sharp score (mTSS). When comparing patients with DAS28-ESR 1.61 versus 1.61 <DAS28-ESR <2.6, 50% and 15% of the two groups demonstrated sustained remission, respectively. Remission was more common in patients with shorter disease duration (2 years) than those with longer duration (>2 years). Among 31 patients who experienced flare, ADA was restarted in 24 patients, and 17 patients of these achieved DAS28-ESR <3.2 within 1-year. Conclusion: During the 5-year ADA-free period, remission rate was persistent in 21% of the patients. ADA-free remission was possible especially in patients with deeper remission (DAS28-ESR 1.61) and shorter disease duration (2 years).

Long-term outcomes after discontinuing biological drugs and tofacitinib in patients with rheumatoid arthritis: A prospective cohort study

“…In the present study, 89% of patients who experienced disease flare regained disease control using rescue therapy with the previous DMARDs. Successful recapture of remission or LDA by restarting the previous regimen has been reported in recent RCTs and observational studies involving bDMARDs and tsDMARDs [ 13 – 15 , 26 – 37 ]. Rapid recovery of disease control with rescue therapy may encourage rheumatologists and RA patients to make a therapeutic decision in favor of bDMARD/tsDMARD discontinuation.…”

“…During a 5-year follow-up, adalimumab-free remission, which was determined by the 28-joint disease activity score based on erythrocyte sedimentation rate, was persistent in 48% of patients at 1 year, 31% at 3 years, and 21% at 5 years. No significant radiological changes were observed in patients who sustained LDA for 5 years, and among them, eight of nine patients (88.9%) maintained structural remission defined as ΔmTSS ≤0.5 per year [ 37 ]. In the present study, the rates of flare patients were estimated to be 45% at 1 year, 64% at 3 years, and 80% at 5 years after the discontinuation of bDMARDs and tofacitinib in RA patients.…”

Defining the Optimal Strategies for Achieving Drug-Free Remission in Rheumatoid Arthritis: A Narrative Review

“…ADA-free remission is possible in patients with established RA (HONOR STUDY) [ 62 ] but more likely in patients with early, MTX-naïve RA (OPTIMA Study) [ 63 ]; remission rates were 21% vs. 66 % at 52 weeks, respectively.…”

“…Although several potential biomarkers of b-DMARD-free remission have been reported, validated measures are yet to be identified. Shorter disease duration [ 8 , 62 , 72 , 78 , 79 ], fewer or absence of erosions [ 71 , 77 ] and low disease activity at baseline [ 8 , 59 , 61 , 70 , 80 , 81 ] have been consistently associated with successful discontinuation in several studies.…”

“…The concept of ‘deep’ clinical remission has been explored by several studies in order to determine what extent of remission provides the greatest predictability of sustained remission following tapering or discontinuation of TNFis. A baseline DAS28 of <2.22 and <1.98 was found to be associated with sustained DFR in the RRR [ 61 ] and HONOR [ 62 ] studies, respectively. In the ANSWER Cohort study, Boolean remission and a sustained period of remission were found to be associated with a better chance of DFR [ 84 ].…”