Background/Purpose: Persistent drug-free remission of RA is a condition close to “cure” of the disease. Long-term drug-free remission is considered rare and challenging to reach, little data are available that report how often persistent drug-free remission can be achieved and what kind of clinical characteristics are associated with such state.

Methods: We analyzed the long-term observational follow-up phase of the randomized controlled RETRO study on tapering and stopping of DMARDS in RA patients in stable remission (DAS28-ESR < 2.6) (1,2). We included patients having completed the 1-year randomized controlled phase of RETRO, in which DMARD treatments were either continued, tapered or stopped. In the long-term extension, (i) patients who successfully stopped, continued DMARD stop, (ii) patients who relapsed in any of the 3 groups continued DMARD treatment, (iii) patients in the continuation arm remaining in remission underwent 50% DMARD tapering follwoed by stopping after 6 months if still being in remission and (iv) patients in the tapering arm remaining in remission underwent DMARD stop. We assessed the percentage of patients in persistent drug-free remission in the overall population and the three randomization groups, the probability of persistent drug-free remission in the intervention groups compared to controls adjusted by baseline aCCP, erosive changes and use of biologic DMARDs in a logistic regression model and the baseline characteristics associated with reaching persistent drug-free remission.

Results: All 141 patients being in the long-term observational follow-up phase of the RETRO study for at least 1 year were analyzed. Among them DMARDs were initially continued (Control, n=38), tapered (Taper, n=50) or stopped (Taper/Stop n=53). 19/141 patients were lost to follow-up and the worst case scenario was assumed that all of them did not reach persistent drug-free remission. Median time after study entry (Q1-Q3) was 69 (37-96) months as by December 2018. Overall number of patients in drug-free remission was 34/141 (24.1%), 10/38 (26%) in the control group, 6/50 (12%) in the taper group and 18/53 (34%) in the taper/stop group. After adjustment for baseline risk factors in the likelihood to reach persistent drug-free remission between the groups (OR:0.76, 95%CI: 0.29-1.99) was highly uncertain. Positive ACPA (OR: 3.38, 1.01 – 11.31) and erosive-state (3.05, 1.32 – 7.06) at baseline were associated with a lower likelihood to reach persistent drug-free remission.

Conclusion: These data show that persistent drug-free remission can be reached in a subset of RA patients following a structured DMARD tapering approach after being in stable long-term DMARD control.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/factors-associated-with-persistent-drug-free-remission-in-patients-with-rheumatoid-arthritis/