Discontinuation of tofacitinib after achieving low disease activity in patients with rheumatoid arthritis: a multicentre, observational study
| Autor: | Koichi Amano, Satoshi Kubo, Kanako Iwata, Hayato Nagasawa, Yoshiya Tanaka, Eiichi Suematsu, Shuji Nagano, Shigeto Tohma, Kunihiro Yamaoka |
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| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Arthritis Rheumatoid Disease activity 03 medical and health sciences 0302 clinical medicine Piperidines Rheumatology Internal medicine medicine Clinical endpoint Humans Rheumatoid factor Pyrroles Pharmacology (medical) In patient Prospective Studies 030212 general & internal medicine Aged 030203 arthritis & rheumatology Tofacitinib business.industry Middle Aged medicine.disease Discontinuation Pyrimidines Treatment Outcome Withholding Treatment Antirheumatic Agents Rheumatoid arthritis Disease Progression Female Observational study business |
| Zdroj: | Rheumatology. 56:1293-1301 |
| ISSN: | 1462-0332 1462-0324 |
| Popis: | Objective To determine whether tofacitinib can be discontinued in patients with RA who achieve low disease activity (LDA). Methods RA patients with LDA after tofacitinib treatment in a phase III and long-term extension study were enrolled in this multicentre, non-randomized, open, prospective, observational study. The decision of discontinuation or continuation of tofacitinib was determined based on patient-physician decision making with informed consent. The primary endpoint was the proportion of patients who remained tofacitinib-free at post-treatment week 52. Clinical outcome was compared between those who continued and those who discontinued tofacitinib. The last observation carried forward method was used for patients who could not discontinue tofacitinib before week 52. Results Of 64 patients, 54 discontinued and 10 continued tofacitinib therapy. At post-treatment week 52, 20 of the 54 patients (37%) of the discontinuation group remained tofacitinib-free without disease flare. Disease activity at post-treatment week 52 was higher in the discontinuation group than the continuation group. Among the discontinuation group, the RF titre at baseline was significantly lower in patients who remained tofacitinib-free than those who did not (40 vs 113 U/ml). In fact, a higher proportion of patients with lower RF remained tofacitinib-free at week 52 compared with those with higher RF at baseline. In patients who could not achieve tofacitinib-free status, re-initiation of tofacitinib or other biologics improved disease activity. Conclusion It is possible to discontinue tofacitinib without flare in about a third of patients with RA. A low RF predicts maintenance of LDA after discontinuation of tofacitinib. |
| Databáze: | OpenAIRE |
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