Rheumatology Advances to Know From 2015

Kevin Deane, MD, PhD


December 23, 2015

In This Article


The following review discusses some of the highlights in rheumatology clinical research in 2015. The focus is on findings that were important in 2015 as well as findings that may have an impact on rheumatologic clinical research and practice in the near future.

Tapering Therapy in Rheumatoid Arthritis

A key area of interest in 2015 in rheumatoid arthritis (RA) has been the tapering or withdrawal of therapies in patients in whom remission or low disease activity has been reached.

In the PRIZE study, Emery and colleagues[1] found that in patients with early RA that was in remission (defined as a Disease Activity Score 28 [DAS28] < 2.6 at 52 weeks) while receiving a combination of full-dose etanercept plus methotrexate, continuing combination therapy with methotrexate and a reduced dose of etanercept (25 mg/wk) resulted in ~44% of patients remaining in remission at 65 weeks. This remission rate was superior to the ~29% seen in those in whom methotrexate was continued and etancercept stopped.

In interim analyses from the RETRO study, Haschka and colleagues[2] found that a certain percentage of patients with RA who reached a DAS < 2.6 while on a variety of therapies could maintain that remission at 12 months; rates varied by the taper of medication reduction. Specifically, in patients who continued their therapy at full-dose, ~16% had relapse at 12 months, compared with ~39% who had their therapy decreased by 50% and ~52% in those who first had their therapy tapered by 50% for 6 months, then stopped.

In a broader exploration of the issue of tapering medications in RA, Kuijper and colleagues[3] performed a systematic review of 25 studies review and found that about one third of patients with low disease activity or remission could have their medications tapered without experiencing a disease flare within 12 months. In particular, they found that dose reduction of anti-tumor necrosis factor (anti-TNF) agents rather than cessation was associated with higher rates of sustained remission.


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