THU0169 Discontinuation of Etanercept in Early Rheumatoid Arthritis Patients who Have Achieved Sustained Remission: Results of the Randomized Controlled Trial in Period 2 of the Encourage Study
Authors: H. Yamanaka, Y. Seto, S. Nagaoka, S.-C. Bae, T. Kasama, S.-K. Lee, H. Kobayashi, Y. Nishioka, Y. Tanaka, T. Takeuchi
Journal: Annals of the Rheumatic Diseases (2014)

<h3>Background</h3> It has been argued whether anti-TNF treatment can be discontinued after the introduction of clinical remission. The ENCOURAGE study has been conducted as an international, multi-institutional prospective study to demonstrate the efficacy and safety of etanercept (ETN) plus methotrexate (MTX) treatment in early RA patients with moderate disease activity (Period 1), and to explore the possibility of discontinuing ETN in patients who have achieved sustained clinical remission. <h3>Objectives</h3> Period 2 of the ENCOURAGE study was conducted to investigate the maintenance of sustained remission for 1 year after randomization to determine whether to continue or discontinue ETN. <h3>Methods</h3> This was a multi-center study, comprising 30 institutes (28 in Japan, 2 in Korea), to investigate the optimal therapeutic strategy for RA patients who had an incomplete response to MTX, moderate disease activity, and a disease duration5 years (n=225, Period 1). A total of 99 patients who maintained clinical remission for 6 months with ETN plus MTX in Period 1 were randomly allocated to either the ETN continuation (C) or discontinuation (D) arm. Resumption of ETN therapy at any time was allowed in arm D, but these patients were excluded from the analysis. The primary endpoint was the remission rate after 1 year, and the analysis was conducted using LOCF or linear extrapolation. <h3>Results</h3> Ninety-nine patients were randomized into either the ETN continuation (C, n=49) or discontinuation (D, n=50) arm. There was no significant difference in baseline disease duration (C: 1.9, D: 2.4 years), DAS28 (1.7, 1.8) or HAQ (0.1, 0.1). At 6 or 12 months after randomization, 90.6 or 87.5% of patients in arm C and 64.3 or 53.6% of patients in arm D maintained clinical remission. No significant radiological progression of joint damage was demonstrated in 89.7% of patients in arm C and 82.6% in arm D; 90.9% of patients in arm C completed the protocol, and 58.9% of arm D completed the protocol without resuming ETN. <h3>Conclusions</h3> Early RA patients who had achieved sustained remission after administration of ETN plus MTX maintained remission through the continuation of this treatment combination; however, more than half of the patients maintained sustained remission even after discontinuation of ETN. <h3>Disclosure of Interest</h3> : H. Yamanaka Grant/research support: Nipon-Kayaku Co.,Ltd., Abott Japan Co., Taisyo-Toyama Co.Ltd., Chugai Pharmaceutical Co, Ltd., Pfizer Japan Inc., Bristol-Mayers, Astellas Pharma, Daiichi-Sankyo, Abbvie GK, Mitsubishi Tanabe Pharma Co., Esai Co. Ltd., Takeda Pharmaceutical Co., MSD, Santen Pharmaceutical Co.Ltd., GlaxoSmithKlein, Teijin Pharma, Asahikasei Pharma Corp., Janssen Pharmaceutical K.K., Speakers bureau: Abbott Japan Co., Chugai Pharmaceutical Co., Takeda Pharmaceutical Co., Pfizer Japan Inc., Daiichi-Sankyo Co., Ltd., Mitsubishi Tanabe Pharma Co., Teijin Pharma Ltd, Y. Seto: None declared, S. Nagaoka Grant/research support: Bristol–Myers K.K.,Janssen Pharmaceutical K.K., S.-C. Bae: None declared, T. Kasama Grant/research support: Abbvie GK, Astellas Pharma, Chugai Pharmaceutical Co. Ltd., Eisai Co., Janssen Pharmaceutical K.K., Mitsubishi Tanabe Pharma Corporation, Pfizer Japan Inc., Speakers bureau: Abbvie GK, Astellas Pharma, Chugai Pharmaceutical Co. Ltd., Eisai Co., Janssen Pharmaceutical K.K., Mitsubishi Tanabe Pharma Corporation, Pfizer Japan Inc., S.-K. Lee: None declared, H. Kobayashi: None declared, Y. Nishioka: None declared, Y. Tanaka Grant/research support: Bristol-Myers, Mitsubishi-Tanabe, Abbvie, MSD, Chugai Pharmaceutical Co., Astellas Pharma, Daiichi-Sankyo Co.Ltd., Speakers bureau: Mitsubishi Tanabe Pharma Co., Eisai Co. Ltd., Chugai Pharmaceutical Co., Ltd., Abbott Japan, Astellas Pharma, Daiichi-Sankyo Co. Ltd., Abbvie GK, Janssen Pharmaceutical K.K., Pfizer Japan Inc., Takeda, Astra-Zeneca, Eli Lilly Japan, GlaxoSmithKline, Quintiles, MSD, AsahiKasei Pharma Corp., T. Takeuchi Grant/research support: Abbott Japan Co., Ltd., Astellas Pharma, Bristol–Myers K.K., Chugai Pharmaceutical Co. Ltd., Daiichi-Sankyo Co. Ltd., Eisai Co., Ltd., Janssen Pharmaceutical K.K., Mitsubishi Tanabe Pharma Co., Pfizer Japan Inc., Sanofi–Aventis K.K., Santen Pharmaceutical Co., Ltd., Takeda Pharmaceutical Co., Ltd.,Teijin Pharma Ltd., Abbvie GK, Asahikasei Pharma Corp., Taisho Toyama Pharmaceutical Co., Ltd., Consultant for: Astra Zeneca K.K., Eli Lilly Japan K.K., Novartis Pharma K.K., Mitsubishi Tanabe Pharma Co., Asahi Kasei Medical K.K.,abbivie GK, Daiichi Sankyo Co.,Ltd., Speakers bureau: Abbott Japan Co., Ltd., Bristol–Myers K.K., Chugai Pharmaceutical Co,. Ltd., Eisai Co., Ltd., Janssen Pharmaceutical K.K., Mitsubishi Tanabe Pharma Co., Pfizer Japan Inc., Takeda Pharmaceutical Co., Ltd., Astellas Pharma, Diaichi-Sankyo Co.,Ltd. <h3>DOI</h3> 10.1136/annrheumdis-2014-eular.2429