Evidence map›Paper›PMID 34233727›Full record

ArticleArthritis research & therapy2021

Switching from TNFα inhibitor to tacrolimus as maintenance therapy in rheumatoid arthritis after achieving low disease activity with TNFα inhibitors and methotrexate: 24-week result from a non-randomized, prospective, active-controlled trial.

Sang Youn Jung, Jung Hee Koh, Ki-Jo Kim, Yong-Wook Park, Hyung-In Yang, Sung Jae Choi, Jisoo Lee, Chan-Bum Choi, Wan-Uk Kim

Open access · goldAbstract readControlled Clinical Trial
In one paragraph

Article in Arthritis research & therapy, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
0.2field-weighted citation impact, top 48% of its field
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

2 citing papers in PubMed, 2 citations in OpenAlex.

  1. Article
  2. Review
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

9 authors at 9 institutions in 2 countries.

Sang Youn Jung *Division of Rheumatology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, South Korea.
Jung Hee Koh *Division of Rheumatology, Department of Internal Medicine, Bucheon St. Mary's Hospital, the Catholic University of Korea, Seoul, South Korea.
Ki-Jo KimDivision of Rheumatology, Department of Internal Medicine, St. Vincent Hospital, the Catholic University of Korea, Seoul, South Korea.
Yong-Wook ParkDivision of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School and Hospital, Gwangju, South Korea.
Hyung-In YangCollege of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, South Korea.
Sung Jae ChoiDivision of Rheumatology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, South Korea.
Jisoo LeeDivision of Rheumatology, Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, South Korea.
Chan-Bum ChoiDepartment of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea.
Wan-Uk KimDivision of Rheumatology, Department of Internal Medicine, Seoul St Mary's Hospital, Center for Integrative Rheumatoid Transcriptomics and Dynamics, College of Medicine, the Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, South Korea. wan725@catholic.ac.kr.ORCID 0000-0001-8224-8496
CHA University Bundang Medical Center · KRChonnam National University Hospital · KREwha Womans University · KRHanyang University Seoul Hospital · KRKorea University · KRKyung Hee University Hospital at Gangdong · KRSt. Mary's Hospital · USThe Catholic University of Korea Bucheon St. Mary's Hospital · KRThe Catholic University of Korea St. Vincent's Hospital · KR

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundTapering or stopping biological disease-modifying anti-rheumatic drugs has been proposed for patients with rheumatoid arthritis (RA) in remission, but it frequently results in high rates of recurrence. This study evaluates the efficacy and safety of tacrolimus (TAC) as maintenance therapy in patients with established RA in remission after receiving combination therapy with tumor necrosis factor inhibitor (TNFi) and methotrexate (MTX).

methodsThis 24-week, prospective, open-label trial included patients who received TNFi and MTX at stable doses for ≥24 weeks and had low disease activity (LDA), measured by Disease Activity Score-28 for ≥12 weeks. Patients selected one of two arms: maintenance (TNFi plus MTX) or switched (TAC plus MTX). The primary outcome was the difference in the proportion of patients maintaining LDA at week 24, which was assessed using a logistic regression model. Adverse events were monitored throughout the study period.

resultsIn efficacy analysis, 80 and 34 patients were included in the maintenance and switched arms, respectively. At week 24, LDA was maintained in 99% and 91% of patients in the maintenance and switched arms, respectively (odds ratio, 0.14; 95% confidence interval, 0.01-1.59). Drug-related adverse effects tended to be more common in the switched arm than in the maintenance arm (20.9% versus 7.1%, respectively) but were well-tolerated.

conclusionThis controlled study tested a novel treatment strategy of switching from TNFi to TAC in RA patients with sustained LDA, and the findings suggested that TNFi can be replaced with TAC in most patients without the patients experiencing flare-ups for at least 24 weeks.

trial registrationKorea CDC CRIS, KCT0005868 . Registered 4 February 2021-retrospectively registered.

Indexed as

Antirheumatic AgentsArthritis, RheumatoidDrug Therapy, CombinationHumansMethotrexateProspective StudiesTacrolimusTreatment OutcomeTumor Necrosis Factor-alphaAntirheumatic AgentsMethotrexateTacrolimusTumor Necrosis Factor-alphaLow disease activityMaintenanceRheumatoid arthritisTacrolimusTumor necrosis factor inhibitors

Identifiers

PMID34233727
PMCPMC8265052
OpenAlexW3178157408

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

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.