Evidence map›Paper›PMID 28955495›Full record

ArticleRMD open2017

Sustainability of TNF-blocker tapering in rheumatoid arthritis over 3 years: long-term follow-up of the STRASS (Spacing of TNF-blocker injections in Rheumatoid ArthritiS Study) randomised controlled trial.

Johanna Sigaux, Florian Bailly, David Hajage, Xavier Mariette, Jacques Morel, Frédérique Gandjbakhch, Violaine Foltz, Laure Gossec, Florence Tubach, Bruno Fautrel

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in RMD open, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Trial
  3. Article
  4. Article
  5. Review
  6. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Johanna SigauxAP-HP, Department of Rheumatology, IMIDIATE Clinical Research Network, Pitié Salpêtrière Hospital, Paris, France.
Florian BaillyAP-HP, Department of Rheumatology, IMIDIATE Clinical Research Network, Pitié Salpêtrière Hospital, Paris, France.
David HajageAP-HP, Département de Biostatistiques, Santé Publique et Information Médicale, Pitié Salpêtrière Hospital, Paris, France.
Xavier MarietteParis Sud University, Le Kremlin Bicêtre, France.
Jacques MorelDepartment of Rheumatology, Montpellier University, Lapeyronie Hospital, Montpellier, France.
Frédérique GandjbakhchAP-HP, Department of Rheumatology, IMIDIATE Clinical Research Network, Pitié Salpêtrière Hospital, Paris, France.
Violaine FoltzAP-HP, Department of Rheumatology, IMIDIATE Clinical Research Network, Pitié Salpêtrière Hospital, Paris, France.
Laure GossecAP-HP, Department of Rheumatology, IMIDIATE Clinical Research Network, Pitié Salpêtrière Hospital, Paris, France.
Florence TubachAP-HP, Department of Rheumatology, IMIDIATE Clinical Research Network, Pitié Salpêtrière Hospital, Paris, France.
Bruno FautrelAP-HP, Department of Rheumatology, IMIDIATE Clinical Research Network, Pitié Salpêtrière Hospital, Paris, France.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionWe have limited data on the sustainability of tumour necrosis factor (TNF)-blocker tapering in rheumatoid arthritis (RA) in remission over the long term in real-life settings. This study aimed to assess the probability of sustained dose reduction of TNF-blockers in an observational 3-year extended follow-up of the Spacing of TNF-blocker injections in Rheumatoid ArthritiS Study (STRASS), a randomised controlled trial comparing progressive TNF-blocker injections (spacing arm (S-arm) to maintenance arm (M-arm)) in patients with RA in stable remission.

methodsIn 2015, clinical data for the completer population were retrospectively collected at 1, 2 and 3 years after the end of the trial. The endpoints were the proportion of patients free of a biological disease-modifying antirheumatic drug (bDMARD) treatment, a sustainably spaced injection of TNF-blockers and a full-dose regimen as well as the mean dose of bDMARD intake and treatment switch rate.

resultsOverall, 96 patients (76.8% of the completers) had data available up to 3 years; 11.5% discontinued TNF-blockers (5.8% vs 18.2% in the M-arm and S-arm, p=0.06), 30.2% had a tapered regimen (28.8% vs 31.8%, p=0.76) and 37.5% retained a full dose (44.2% vs 29.5%, p=0.14). The mean TNF-blocker dose quotient was 66% of the full dose (74% vs 58% in the M-arm and S-arm, p=0.06); 20.8% switched to another bDMARD (21.2% vs 20.5%, p=0.94).

conclusionSustained TNF-blocker de-escalation or withdrawal is achievable in 41% of patients over 3 years with limited dose reduction. Optimal strategies remain to be determined to maintain remission after TNF-blocker tapering or discontinuation.

Indexed as

Anti-tnfRheumatoid ArthritisTreatment

Identifiers

PMID28955495
PMCPMC5604723

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.