THU0220 Discontinuation of biologic dmards in a real-life population of patients in remission: outcome and predictors
Authors: S. Arnold, V.K. Jaeger, A. Scherer, U.A. Walker, D. Kyburz
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Data from randomised controlled trials have shown that in patients with sustained remission discontinuation of bDMARD therapy is feasible. However, the criteria for selecting patients that will successfully remain in remission after bDMARD discontinuation remain to be defined. <h3>Objectives</h3> To assess the rate of loss of remission after discontinuation of bDMARDs in a real life setting and to identify predictors in a large cohort of patients. <h3>Methods</h3> Adult RA patients in bDMARD-free remission from the Swiss clinical quality management in rheumatic diseases registry (SCQM) were included. bDMARD-free remission was defined as a discontinuation of the bDMARD and a DAS28 ≤2.6 at a clinical visit within 90 days prior to 30 days after the bDMARD discontinuation. Loss of remission was defined as a DAS28 &gt;2.6 or restart of a bDMARD. Patients treated with rituximab were excluded. Kaplan-Meier methods were applied and cox regression was used for multivariable analyses (adjusted for sex, anti-CCP, RF, DAS28, bDMARD Type, CDAI, therapy with conventional DMARDs, number of previous bDMARDs). Missing data were imputed using multiple imputation. <h3>Results</h3> Between 1997 and 2017, 318 patients achieved a bDMARD-free remission (table1). Median observation time was 2.8 years (IQR 1.2–4.9). 241 patients lost remission (76%), 54% of those re-started a bDMARD, 34% experienced a DAS28 flare and 12% did both. The median time to loss of remission was 0.9 years (95% CI 0.7–1.0). 76% discontinued a TNFα-inhibitor, 6% stopped abatacept, 14% tocilizumab and 4% tofacitinib. Women lost remission faster than men (figure 1A; p=0.005); this was also seen in multivariable analysis (HR 1.4, p=0.03). Longer disease duration was associated with a faster loss of remission (figure 1B; p=0.03) also in multivariable analysis (HR[4–8 years] 1.6, p=0.03, HR[8–13 years] 1.6, p=0.01, HR[&gt;13 years] 1.5, p=0.035 <i>vs</i> 0–4 years disease duration). Remission was lost faster by patients who discontinued tofacitinib compared to those who stopped a TNFα-inhibitor (HR 2.3, p=0.01) also after adjustment (HR 2.0, p=0.047). There was a trend for a faster loss of remission in patients with a higher disease activity as measured by the CDAI at baseline (figure 1C; p=0.7); this association was significant in multivariable analysis (HR[CDAI low disease activity] 1.6, p=0.03, HR[CDAI moderate/high disease activity] 2.5, p=0.003, both <i>vs</i> CDAI remission). Patients who received MTX/leflunomide during the observation period lost remission less rapidly (figure 1D; p=0.006) also in multivariable analysis (HR 0.8, p=0.046). <h3>Conclusions</h3> In a large real-life cohort of RA patients that achieved DAS28 remission and stopped therapy with bDMARD the majority lost remission within less than a year. Predictors for loss of remission included female sex, longer disease duration, a higher CDAI score and absence of cDMARD therapy. This suggests that discontinuation of bDMARD should be considered in patients on cDMARD therapy, fulfilling the more stringent remission criteria by CDAI. <h3>Disclosure of Interest</h3> None declared