ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 585

Outcomes after Discontinuing Tumor Necrosis Factor Inhibitor in Rheumatoid Arthritis: 2 Years of ‘post-Golimumab’ after Completion of the 5-Year Extension Study in Korea

Kichul Shin1, Hyun Mi Kwon2, Seong-Wook Kang3, Won Park4, Sung-Hwan Park5,6, Chang-Hee Suh7,8, Hyun Ah Kim9,10, Seung-Geun Lee11, Choong Ki Lee12, Sang-Cheol Bae13, Soo-Kon Lee14 and Yeong Wook Song15, 1Division of Rheumatology, SMG-SNU Boramae Medical Center, Seoul, South Korea, 2Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea, 3Division of Rheumatology, Chungnam National University Hospital, Gwangju, South Korea, 4Division of Rheumatology, Inha University Hospital, Incheon, South Korea, 5Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea, 6Division of Rheumatology, Department of Internal Medicine, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, South Korea, 7Allergy-Rheumatology, Ajou University School of Medicine, Suwon, South Korea, 8Division of Rheumatology, Ajou University Hospital, Suwon, South Korea, 9Internal Medicine, Hallym Univ Sacred Heart Hosp, Anyang, South Korea, 10Division of Rheumatology, Hanlim University Hospital, Anyang, South Korea, 11Division of Rheumatology, Busan University Hospital, Busan, South Korea, 12Division of Rheumatology, Youngnam National University Hospital, Daegu, South Korea, 13Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea, 14Division of Rheumatology, Yonsei University College of Medicine, Seoul, South Korea, 15Division of Rheumatology, Department of internal medicine, Seoul National University Hospital, Seoul, South Korea

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords:

Session Information

Date: Sunday, November 8, 2015

Title: Rheumatoid Arthritis - Small Molecules, Biologics and Gene Therapy Poster I

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: Tumor necrosis factor inhibitors (TNFi) have helped patients achieve remarkable outcomes as in improving synovitis and halting structural damages in severe cases of rheumatoid arthritis (RA). Nowadays academic interests lie towards strategies of ‘tapering’ or ‘discontinuing’ biological therapy, especially in cases where patients are being maintained in clinical remission for an adequate period. However, not many studies have traced the outcomes after discontinuing TNFi. 

Methods: The ‘Investigation of outcomes after Golimumab discontinuation’ or GOLD study, is an observational study participated by 10 centers nationwide, following up clinical data of Korean RA patients who were enrolled in the 5-year extension study of GO-BEFORE and GO-FORWARD. Medical records of the 2-year post-golimumab period were reviewed and pertinent clinical data including DAS scores, prescriptions, comorbidities, laboratory findings, as well as radiographic images were analyzed.

Results: The 60 RA patients (male 5, female 55) had the following mean values at discontinuation (baseline); age of 51.0 years, disease duration of 16.5 years, and a DAS28-CRP score of 2.71. At the 2-year time point, 9/60 (15%) patients had restarted biologics. The mean period restarting biologics was 18.7 months (range 4~28) after discontinuation. Baseline characteristics of the ‘biologic restarters’ and ‘non-biologic users’ are depicted in the table. New joint damage was discovered only in non-biologic users (4/51 patients) at 2 years.

Conclusion: The GOLD study based on ‘deliberate’ discontinuation of TNFi in RA patients with low disease activity shows that patients with higher swollen joint counts, physician’s global assessment score at the time point of discontinuation tend to restart biologics in the near future. New joint damage ensued only in those off biologics.

Table. Baseline characteristics between the 2 groups at discontinuation*

 

Biologic

Restarters

(n= 9)

Non-biologic

Users

(n= 51)

P value

Age, years

49.9

51.2

0.73

ACR20, %

66

82

0.27

ACR50, %

44

55

0.56

ACR70, %

44

31

0.44

DAS remission, %

33

53

0.27

Rheumatoid factor, %

89 (8/9)

47 (24/51)

0.16

Anti-CCP, %

100

100

–

Swollen joint count, n

10.1

1.7

< 0.01

Tender joint count, n

10.7

3.8

0.28

Patient’s global assessment (0-10)

4.25

3.27

0.29

Physician’s global assessment (0-10)

3.21

1.69

0.05

HAQ

1.291

0.666

0.15

C-reactive protein, mg/dL

0.34

0.52

0.07

Erythrocyte sedimentation rate, mm/hr

41.5

32.2

0.42

DAS28-CRP

3.18

2.65

0.29

DAS28-ESR

4.18

3.27

0.17

Patient’s with bone erosion, %

88 (7/8)

49 (25/51)

0.12

Patient’s with joint space narrowing, %

75 (6/8)

47 (24/51)

0.44

 Mean values are presented.

*Based on whether biologic had been restarted within 2 years after golimumab discontinuation 

Disclosure: K. Shin, None; H. M. Kwon, None; S. W. Kang, None; W. Park, None; S. H. Park, None; C. H. Suh, None; H. A. Kim, None; S. G. Lee, None; C. K. Lee, None; S. C. Bae, None; S. K. Lee, None; Y. W. Song, None.

To cite this abstract in AMA style:

Shin K, Kwon HM, Kang SW, Park W, Park SH, Suh CH, Kim HA, Lee SG, Lee CK, Bae SC, Lee SK, Song YW. Outcomes after Discontinuing Tumor Necrosis Factor Inhibitor in Rheumatoid Arthritis: 2 Years of ‘post-Golimumab’ after Completion of the 5-Year Extension Study in Korea [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/outcomes-after-discontinuing-tumor-necrosis-factor-inhibitor-in-rheumatoid-arthritis-2-years-of-post-golimumab-after-completion-of-the-5-year-extension-study-in-korea/. Accessed .

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