Trial reportAnnals of the rheumatic diseases2023
Effect of tapered versus stable treatment with tumour necrosis factor inhibitors on disease flares in patients with rheumatoid arthritis in remission: a randomised, open label, non-inferiority trial.
Trial report in Annals of the rheumatic diseases, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01881308 (REmission in Rheumatoid Arthritis - Assessing WIthrawal of Disease-modifying Antirheumatic Drugs in a Non-inferiority Design), which is not on this map. Cited by 10 papers, 2 of them syntheses that pooled it.
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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.
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.
REmission in Rheumatoid Arthritis - Assessing WIthrawal of Disease-modifying Antirheumatic Drugs in a Non-inferiority Design
Who cites it
10 citing papers in PubMed, 2 syntheses or guidelines pooled it, 17 citations in OpenAlex.
- Temporal Patterns of Outcomes After DMARD Tapering or Withdrawal in Rheumatoid Arthritis With Sustained Disease Control: A Systematic Review and Meta-Analysis.Clinical and translational science · 2026Pooled it
- How useful is contrast-enhanced ultrasound in rheumatoid arthritis? A systematic review with meta-analysis on the comparison between contrast-enhanced ultrasound and colour or power Doppler ultrasound.La Radiologia medica · 2025Pooled it
- Clinical and molecular data to predict flares in DMARD optimization in rheumatoid arthritis: a randomized, controlled, open-label, non-inferiority trial.Rheumatology (Oxford, England) · 2026Trial
- Innate lymphoid cells in rheumatoid arthritis as mediators of pathology and resolution.Nature reviews. Rheumatology · 2026Review
- Sustaining remission in rheumatoid arthritis: the role of clinical deep remission and its implications for drug tapering.RMD open · 2026Article
- TWEAK receptor (Fn14) exacerbates TNF-α-induced inflammation in rheumatoid arthritis synovial fibroblasts and influences response to anti-TNF-α therapy.Cellular & molecular immunology · 2026Article
- Biological tapering is cost-effective in patients with inflammatory arthritis in the biosimilar era: secondary analyses on the randomised BIODOPT trial.EULAR rheumatology open · 2025Article
- Exploration of potential novel drug targets for rheumatoid arthritis by plasma proteome screening.PLoS computational biology · 2025Article
- Con: clinical remission in asthma - not yet there.European respiratory review : an official journal of the European Respiratory Society · 2025Review
- Article
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Authors and funding
19 authors at 13 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesMany patients with rheumatoid arthritis (RA) require treatment with tumour necrosis factor inhibitor (TNFi) to reach remission. It is debated whether tapering of TNFi to discontinuation should be considered in sustained remission. The aim of ARCTIC REWIND TNFi was to assess the effect of tapering TNFi to withdrawal compared with stable treatment on the risk of disease activity flares in patients with RA in remission ≥1 year.
methodsThis randomised, open-label, non-inferiority trial was undertaken at nine Norwegian rheumatology departments. Patients with RA in remission ≥12 months on stable TNFi therapy were allocated by computer-based block-randomisation to tapering to discontinuation of TNFi or stable TNFi. Conventional synthetic disease-modifying antirheumatic co-medication was unchanged. The primary endpoint was disease flare during the 12-month study period (non-inferiority margin 20%), assessed in the per-protocol population.
resultsBetween June 2013 and January 2019, 99 patients were enrolled and 92 received the allocated treatment strategy. Eighty-four patients were included in the per-protocol population. In the tapering TNFi group, 27/43 (63%) experienced a flare during 12 months, compared with 2/41 (5%) in the stable TNFi group; risk difference (95% CI) 58% (42% to 74%). The tapering strategy was not non-inferior to continued stable treatment. The number of total/serious adverse events was 49/3 in the tapering group, 57/2 in the stable group.
conclusionIn patients with RA in remission for more than 1 year while using TNFi, an increase in flare rate was reported in those who tapered TNFi to discontinuation. However, most regained remission after reinstatement of full-dose treatment. TRIAL REGISTRATION NUMBERS: EudraCT: 2012-005275-14 and clinicaltrials.gov: NCT01881308.
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