Relapse rates after elective discontinuation of anti-TNF therapy in rheumatoid arthritis: a meta-analysis and review of literature.

Autor: Mangoni AA; 1Department of Clinical Pharmacology, Flinders University and Flinders Medical Centre, Bedford Park, SA 5042 Australia., Al Okaily F; 2Prince Sultan Military Medical City, Riyadh, Saudi Arabia., Almoallim H; 3Department of Medicine, Umm Alqura University, Jeddah, Kingdom of Saudi Arabia., Al Rashidi S; 2Prince Sultan Military Medical City, Riyadh, Saudi Arabia., Mohammed RHA; 4Rheumatology and Clinical Immunology, Department of Rheumatology and Rehabilitation, School of Medicine, Cairo University Hospitals, Cairo, Egypt.; 5Internal Medicine Department, Alhada Armed Forces Hospital, Taif, Kingdom of Saudi Arabia., Barbary A; 6Department of Rheumatology and Rehabilitation, Tanta University Faculty of Medicine, Elgesh Street, Tanta, Gharbeia Egypt.
Jazyk: angličtina
Zdroj: BMC rheumatology [BMC Rheumatol] 2019 Mar 08; Vol. 3, pp. 10. Date of Electronic Publication: 2019 Mar 08 (Print Publication: 2019).
DOI: 10.1186/s41927-019-0058-7
Abstrakt: Background: Inhibitors of tumor necrosis factor alpha (TNF-α) are current mainstay of therapies for rheumatoid arthritis (RA). The decision when to withdraw TNF-α inhibitors after achieving remission and the incidence of relapse rates with elective discontinuation are both important questions that demand intense survey in these patients. In this meta-analysis we aimed to estimate the magnitude of relapse rate after elective TNF-α inhibitor discontinuation in RA patients with remission.
Methods: Systematic searches of PubMed/MEDLINE, Cochrane Library databases, grey literature (unpublished and ongoing trials) from the WHO International Clinical Trials Registry Platform and the US National Institutes of Health were performed for studies reporting the outcomes of elective discontinuation of TNF-α inhibitor in RA patients after remission. Random-effects models for meta-analyses were conducted on extracted data.
Results: Out of 390 references screened, 16 RCTs were included. Meta-analysis of 1264 patient data revealed a relapse rate of 0.47 (95% CI 0.41-0.54). Sensitivity analysis showed that none of the studies had higher influence on the results.
Conclusions: Almost half of all the RA patients in remission relapse after elective TNF-α inhibitor discontinuation. This information might be useful when considering this management option with individual patients.
Competing Interests: Not applicable (systematic review).Not applicable (systematic review).The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Databáze: MEDLINE
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