FRI0208 The possibility and predictive factors of maintaining low disease activity and joint structure after discontinuation of infliximab in ra patients: results from 3-year experience of rrr study
Authors: Y. Tanaka, T. Takeuchi, T. Mimori, N. Miyasaka, T. Koike
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> Clinical remission is a goal for every RA patient, especially for patients with early-stage RA. It has also been reported that biologic-free remission could be obtained beyond the achievement of clinical remission. We previously presented the findings of the RRR study that low disease activity (LDA) could be maintained for at least 1 year even after discontinuation of infliximab (IFX) also in established RA pts(1). <h3>Objectives</h3> The follow-up study was performed for another 2 years to seek the predictive factors for retaining LDA and joint structure for 3 years after cessation of IFX treatment. <h3>Methods</h3> A hundred and fourteen RA pts who maintained LDA for over 24 weeks after initiation of IFX and gave informed consent discontinued IFX. DAS28 data were available in 102 pts after year 1. We measured DAS28 and total sharp score (TSS) at year 3, and conducted <i>post hoc</i> analysis to determine correlated predictive factors with maintaining of LDA and joint structure. <h3>Results</h3> Among the 102 pts who discontinued IFX, 56 pts (55%) maintained LDA at year 1 after discontinuing IFX. Four pts withdrew from the study and 50 pts (51%) retained LDA at year 2. After that, another 4 pts withdrew, and 38 pts (40%) stayed in LDA for 3 years after stopping IFX. 78.6% and 74.0% of pts who maintained LDA at year 1 and 2 retained LDA at year 2 and 3 respectively. Patient characteristics at initiation and discontinuation of IFX in RRR 3-year achieved pts were analyzed by univariable logistic regression analysis by comparing with RRR 1-year failed pts. Age (49.9±12.0), DAS28 (1.94±0.72) and TSS (57±47) at initiation of IFX in RRR 3-year achieved pts were significantly lower than 1-year failed pts. Although disease duration at baseline in 3-year achieved pts (4.8±4.6) was also significantly lower than 1-year failed pts, there were some pts with that of over 8.5 years in 3-year achieved group. X-ray evaluation at year 3 was made in 19 pts out of 49 pts whose TSS at 1 year after discontinuation of IFX was evaluated. Change of TSS from baseline in LDA achieved and non-achieved groups were 2.5±2.9 and 0.4±0.7 respectively (p=0.067), which means radiographic progression occurred independent of disease activity. In addition, TSS in clinical relevant radiographic progression (change of TSS ≥3; CRRP) group at initiation of IFX (70.2±36.3) was higher than that in non-CRRP group (39.9±37.9, p=0.165). It is important to suppress damage-associated HAQ affected by irreversible joint destruction for maintaining functional remission, and TSS progression should be kept under 50 (2). In RRR study, there were significantly more pts with TSS over 50 in CRRP group than in non-CRRP group (p=0.038). <h3>Conclusions</h3> IFX-free remission could be maintained for 3 years in 40% of pts even in long-standing RA, and over 70% of pts who retained LDA for at least 1 year could be maintained LDA for 3 years. The study suggests that initiation of IFX treatment before progression of structural damage and discontinuation of IFX after inducing deep remission may increase the possibility of attaining IFX-free remission with structural and functional remission. <h3>References</h3> Tanaka Y, et al. Ann Rheum Dis 2010;69:1286. Smolen J, et al. Ann Rheum Dis 2010;69:1058. <b>Disclosure of Interest</b>: Y. Tanaka Grant/research support from: Abbott Japan, Astellas Pharma, Bristol-Myers Squibb, Chugai Pharmaceutical, Eisai, Janssen Pharmaceutical, Mitsubishi Tanabe Pharma, MSD K.K., Speakers bureau: Abbott Japan, Actelion Pharmaceuticals Japan, Astellas Pharma, AstraZeneca, Chugai Pharmaceutical, Eisai, Eli Lilly Japan, Daiichi Sankyo, GlaxoSmithKline, Janssen Pharmaceutical, Mitsubishi Tanabe Pharma, Nippon Kayaku, Ono Pharmaceutical, Otsuka Pharmaceutical, Pfizer Japan, Quintiles Transnational Japan, Santen Pharmaceutical, UCB Japan, T. Takeuchi Consultant for: Abbott Japan, Bristol-Myers-Squibb, Chugai Pharmaceutical, Eisai, Janssen Pharmaceutical, Mitsubishi Tanabe Pharma, Novartis, Pfizer Japan, Speakers bureau: Abbott Japan, Chugai Pharmaceutical, Eisai, Mitsubishi Tanabe Pharma, Takeda Pharmaceutical, T. Mimori Consultant for: Abbott Japan, Asahikasei Pharma, Astellas Pharma, Bristol-Myers-Squibb, Chugai Pharmaceutical, Eisai, Mitsubishi Tanabe Pharma, Takeda Pharmaceutical, Speakers bureau: Abbott Japan, Chugai Pharmaceutical, Eisai, Mitsubishi Tanabe Pharma, Pfizer Japan, N. Miyasaka Consultant for: Abbott Japan, Bristol-Myers-Squibb, Chugai Pharmaceutical, Eisai, Janssen Pharmaceutical, Mitsubishi Tanabe Pharma, Speakers bureau: Abbott Japan, Chugai Pharmaceutical, Eisai, Mitsubishi Tanabe Pharma, Pfizer Japan, Takeda Pharmaceutical, T. Koike Speakers bureau: Abbott Japan, Astellas Pharma, Bristol-Myers-Squibb, Chugai Pharmaceutical, Eisai, Janssen Pharmaceutical, Mitsubishi Tanabe Pharma, Santen Pharmaceutical, Taisyo Toyama Pharmaceutical, Takeda Pharmaceutical, Teijin Pharma, UCB Japan