SynthesisRMD open2020
DMARD-free remission as novel treatment target in rheumatoid arthritis: A systematic literature review of achievability and sustainability.
Synthesis in RMD open, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers.
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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.
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Who cites it
26 citing papers in PubMed.
- Qushi Juanbi Granules Combined with Shenling Baizhu Powder in Rheumatoid Arthritis Patients with Low Disease Activity and Pi Deficiency and Dampness Pattern: A Randomized, Double-Blind, Controlled Trial.Chinese journal of integrative medicine · 2026Trial
- Longitudinal changes in patient characteristics as drivers of clinical outcomes in the Early Undifferentiated PolyArthritis (EUPA) cohort.Rheumatology (Oxford, England) · 2026Trial
- Longitudinal changes in patient characteristics as drivers of clinical outcomes in the Early Undifferentiated PolyArthritis (EUPA) cohort.Rheumatology (Oxford, England) · 2026Trial
- Prediction of flare following remission and treatment withdrawal in early rheumatoid arthritis: post hoc analysis of a phase IIIb trial with abatacept.Arthritis research & therapy · 2022Trial
- Tapering towards DMARD-free remission in established rheumatoid arthritis: 2-year results of the TARA trial.Annals of the rheumatic diseases · 2020Trial
- Long-Term Outcomes in Seronegative Rheumatoid Arthritis.Arthritis care & research · 2026Article
- Novel insights into the biology of childhood arthritis- lessons learned from the synovium.Arthritis research & therapy · 2025Review
- Article
- Tapering towards drug-free remission in rheumatoid arthritis: assessment of clinical outcomes and drug savings.Rheumatology advances in practice · 2025Article
- The prognostic value of IgA anti-citrullinated protein antibodies and rheumatoid factor in an early arthritis population with a treat-to-target approach.Immunologic research · 2024Article
- Disentangling heterogeneity in contemporary undifferentiated arthritis - A large cohort study using latent class analysis.Seminars in arthritis and rheumatism · 2023Article
- Tailored therapeutic decision of rheumatoid arthritis using proteomic strategies: how to start and when to stop?Clinical proteomics · 2023Review
- Factors associated with discontinuation of biologics in patients with inflammatory arthritis in remission: data from the BIOBADASER registry.Arthritis research & therapy · 2023Observational
- Article
- ACPA-negative and ACPA-positive RA patients achieving disease resolution demonstrate distinct patterns of MRI-detected joint-inflammation.Rheumatology (Oxford, England) · 2022Article
- Sustained DMARD-free remission in rheumatoid arthritis - about concepts and moving towards practice.Joint bone spine · 2022Review
- Hand and foot MRI in contemporary undifferentiated arthritis: in which patients is MRI valuable to detect rheumatoid arthritis early? A large prospective study.Rheumatology (Oxford, England) · 2022Article
- Early persistence on therapy impacts drug-free remission: a case-control study in a cohort of Hispanic patients with recent-onset rheumatoid arthritis.Arthritis research & therapy · 2022Article
- Accounting for missing data caused by drug cessation in observational comparative effectiveness research: a simulation study.Annals of the rheumatic diseases · 2022Article
- Unraveling heterogeneity within ACPA-negative rheumatoid arthritis: the subgroup of patients with a strong clinical and serological response to initiation of DMARD treatment favor disease resolution.Arthritis research & therapy · 2022Article
Corrections and comments
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesAlthough current treatment guidelines for rheumatoid arthritis (RA) suggest tapering disease-modifying anti-rheumatic drugs (DMARDs), it is unclear whether DMARD-free remission (DFR) is an achievable and sustainable outcome. Therefore, we systematically reviewed the literature to determine the prevalence and sustainability of DFR and evaluated potential predictors for DFR.
methodsA systematic literature search was performed in March 2019 in multiple databases. All clinical trials and observational studies reporting on discontinuation of DMARDs in RA patients in remission were included. Our quality assessment included a general assessment and assessment of the description of DFR. Prevalence of DFR and its sustainability and flares during tapering and after DMARD stop were summarised. Also, potential predictors for achieving DFR were reviewed.
resultsFrom 631 articles, 51 were included, comprising 14 clinical trials and 5 observational studies. DFR definition differed, especially for the duration of DMARD-free state. Considering only high- and moderate-quality studies, DFR was achieved in 5.0%-24.3% and sustained DFR (duration>12 months) in 11.6%-19.4% (both relative to the number of patients eligible for tapering). Flares occurred frequently during DMARD tapering (41.8%-75.0%) and in the first year after achieving DFR (10.4%-11.8%), while late flares, >1 year after DMARD-stop, were infrequent (0.3%-3.5%). Many patient characteristics lacked association with DFR. Absence of autoantibodies and shared epitope alleles increased the chance of achieving DFR.
conclusionsDFR is achievable in RA and is sustainable in ~10%-20% of patients. DFR can become an important outcome measure for clinical trials and requires consistency in the definition. Considering the high rate of flares in the first year after DMARD stop, a DMARD-free follow-up of >12 months is advisable to evaluate sustainability.
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