Predictors of biologic-free disease control in patients with rheumatoid arthritis after stopping tumor necrosis factor inhibitor treatment

Marjan Ghiti Moghadam, Femke B.G. Lamers-Karnebeek, Harald E. Vonkeman, Peter M. ten Klooster, Janneke Tekstra, Barbara van Schaeybroeck, Ruth Klaasen, Marieke van Onna, Hein J. Bernelot Moens, Henk Visser, Annemarie M. Schilder, Marc R. Kok, Robert B.M. Landewé, Piet L.C.M. van Riel, Mart A.F.J. van de Laar, Tim L. Jansen

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Abstract

The aim of this study was to identify predictors of prolonged disease control after discontinuation of tumor necrosis factor inhibitor (TNFi) treatment in patients with rheumatoid arthritis (RA). Post-hoc analysis of 439 RA patients (67.3% rheumatoid factor positive) with longstanding RA in remission or with stable low disease activity, randomized to stopping TNFi treatment in the multicenter POET trial. Prolonged acceptable disease control was defined as not restarting TNFi treatment within 12 months after stopping. Baseline demographic and disease-related variables were included in univariate and multivariate logistic regression analysis for identifying predictors of relapse. One year after baseline, 220 patients (50.1%) had not restarted TNFi treatment. Use of an anti-TNF monoclonal antibody (versus a receptor antagonist, OR = 2.41; 95% CI: 1.58\3.67), \10 yrs. disease duration (OR = 2.15; 95% CI: 1.42\3.26) and low or moderate multi-biomarker disease activity (MBDA) scores (OR = 2.00; 95% CI: 1.10\3.64) at baseline were independently predictive of successful TNFi discontinuation (area under the receiver operating characteristic curve = 0.66; 95% CI: 0.61\0.71). Results were similar when using no physician-reported flare as the criterion. TNFi-free survival was significantly different for patient groups based on the number of predictors present, ranging from 21.4% of patients with no predictor present to 66.7% of patients with all three predictors present. Patients using an anti-TNF monoclonal antibody, with shorter disease duration and low or moderate baseline MBDA score are most likely to achieve prolonged disease control after TNFi discontinuation. Netherlands Trial Register NTR3112 , 21 October 2011.
Original languageEnglish
Pages (from-to)1-8
Number of pages8
JournalBMC Rheumatology
Volume3
Issue number3
DOIs
Publication statusPublished - 13 Jun 2019

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Biological Products
Rheumatoid Arthritis
Tumor Necrosis Factor-alpha
Therapeutics
Biomarkers
Monoclonal Antibodies
Rheumatoid Factor
ROC Curve
Netherlands
Multicenter Studies
Logistic Models
Regression Analysis
Demography
Physicians
Recurrence
Survival

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Ghiti Moghadam, Marjan ; Lamers-Karnebeek, Femke B.G. ; Vonkeman, Harald E. ; ten Klooster, Peter M. ; Tekstra, Janneke ; van Schaeybroeck, Barbara ; Klaasen, Ruth ; van Onna, Marieke ; Bernelot Moens, Hein J. ; Visser, Henk ; Schilder, Annemarie M. ; Kok, Marc R. ; Landewé, Robert B.M. ; van Riel, Piet L.C.M. ; van de Laar, Mart A.F.J. ; Jansen, Tim L. / Predictors of biologic-free disease control in patients with rheumatoid arthritis after stopping tumor necrosis factor inhibitor treatment. In: BMC Rheumatology. 2019 ; Vol. 3, No. 3. pp. 1-8.
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title = "Predictors of biologic-free disease control in patients with rheumatoid arthritis after stopping tumor necrosis factor inhibitor treatment",
abstract = "The aim of this study was to identify predictors of prolonged disease control after discontinuation of tumor necrosis factor inhibitor (TNFi) treatment in patients with rheumatoid arthritis (RA). Post-hoc analysis of 439 RA patients (67.3{\%} rheumatoid factor positive) with longstanding RA in remission or with stable low disease activity, randomized to stopping TNFi treatment in the multicenter POET trial. Prolonged acceptable disease control was defined as not restarting TNFi treatment within 12 months after stopping. Baseline demographic and disease-related variables were included in univariate and multivariate logistic regression analysis for identifying predictors of relapse. One year after baseline, 220 patients (50.1{\%}) had not restarted TNFi treatment. Use of an anti-TNF monoclonal antibody (versus a receptor antagonist, OR = 2.41; 95{\%} CI: 1.58\3.67), \10 yrs. disease duration (OR = 2.15; 95{\%} CI: 1.42\3.26) and low or moderate multi-biomarker disease activity (MBDA) scores (OR = 2.00; 95{\%} CI: 1.10\3.64) at baseline were independently predictive of successful TNFi discontinuation (area under the receiver operating characteristic curve = 0.66; 95{\%} CI: 0.61\0.71). Results were similar when using no physician-reported flare as the criterion. TNFi-free survival was significantly different for patient groups based on the number of predictors present, ranging from 21.4{\%} of patients with no predictor present to 66.7{\%} of patients with all three predictors present. Patients using an anti-TNF monoclonal antibody, with shorter disease duration and low or moderate baseline MBDA score are most likely to achieve prolonged disease control after TNFi discontinuation. Netherlands Trial Register NTR3112 , 21 October 2011.",
author = "{Ghiti Moghadam}, Marjan and Lamers-Karnebeek, {Femke B.G.} and Vonkeman, {Harald E.} and {ten Klooster}, {Peter M.} and Janneke Tekstra and {van Schaeybroeck}, Barbara and Ruth Klaasen and {van Onna}, Marieke and {Bernelot Moens}, {Hein J.} and Henk Visser and Schilder, {Annemarie M.} and Kok, {Marc R.} and Landew{\'e}, {Robert B.M.} and {van Riel}, {Piet L.C.M.} and {van de Laar}, {Mart A.F.J.} and Jansen, {Tim L.}",
year = "2019",
month = "6",
day = "13",
doi = "10.1186/s41927-019-0071-x",
language = "English",
volume = "3",
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Ghiti Moghadam, M, Lamers-Karnebeek, FBG, Vonkeman, HE, ten Klooster, PM, Tekstra, J, van Schaeybroeck, B, Klaasen, R, van Onna, M, Bernelot Moens, HJ, Visser, H, Schilder, AM, Kok, MR, Landewé, RBM, van Riel, PLCM, van de Laar, MAFJ & Jansen, TL 2019, 'Predictors of biologic-free disease control in patients with rheumatoid arthritis after stopping tumor necrosis factor inhibitor treatment' BMC Rheumatology, vol. 3, no. 3, pp. 1-8. https://doi.org/10.1186/s41927-019-0071-x

Predictors of biologic-free disease control in patients with rheumatoid arthritis after stopping tumor necrosis factor inhibitor treatment. / Ghiti Moghadam, Marjan; Lamers-Karnebeek, Femke B.G.; Vonkeman, Harald E.; ten Klooster, Peter M.; Tekstra, Janneke; van Schaeybroeck, Barbara; Klaasen, Ruth; van Onna, Marieke; Bernelot Moens, Hein J.; Visser, Henk; Schilder, Annemarie M.; Kok, Marc R.; Landewé, Robert B.M.; van Riel, Piet L.C.M.; van de Laar, Mart A.F.J.; Jansen, Tim L.

In: BMC Rheumatology, Vol. 3, No. 3, 13.06.2019, p. 1-8.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Predictors of biologic-free disease control in patients with rheumatoid arthritis after stopping tumor necrosis factor inhibitor treatment

AU - Ghiti Moghadam, Marjan

AU - Lamers-Karnebeek, Femke B.G.

AU - Vonkeman, Harald E.

AU - ten Klooster, Peter M.

AU - Tekstra, Janneke

AU - van Schaeybroeck, Barbara

AU - Klaasen, Ruth

AU - van Onna, Marieke

AU - Bernelot Moens, Hein J.

AU - Visser, Henk

AU - Schilder, Annemarie M.

AU - Kok, Marc R.

AU - Landewé, Robert B.M.

AU - van Riel, Piet L.C.M.

AU - van de Laar, Mart A.F.J.

AU - Jansen, Tim L.

PY - 2019/6/13

Y1 - 2019/6/13

N2 - The aim of this study was to identify predictors of prolonged disease control after discontinuation of tumor necrosis factor inhibitor (TNFi) treatment in patients with rheumatoid arthritis (RA). Post-hoc analysis of 439 RA patients (67.3% rheumatoid factor positive) with longstanding RA in remission or with stable low disease activity, randomized to stopping TNFi treatment in the multicenter POET trial. Prolonged acceptable disease control was defined as not restarting TNFi treatment within 12 months after stopping. Baseline demographic and disease-related variables were included in univariate and multivariate logistic regression analysis for identifying predictors of relapse. One year after baseline, 220 patients (50.1%) had not restarted TNFi treatment. Use of an anti-TNF monoclonal antibody (versus a receptor antagonist, OR = 2.41; 95% CI: 1.58\3.67), \10 yrs. disease duration (OR = 2.15; 95% CI: 1.42\3.26) and low or moderate multi-biomarker disease activity (MBDA) scores (OR = 2.00; 95% CI: 1.10\3.64) at baseline were independently predictive of successful TNFi discontinuation (area under the receiver operating characteristic curve = 0.66; 95% CI: 0.61\0.71). Results were similar when using no physician-reported flare as the criterion. TNFi-free survival was significantly different for patient groups based on the number of predictors present, ranging from 21.4% of patients with no predictor present to 66.7% of patients with all three predictors present. Patients using an anti-TNF monoclonal antibody, with shorter disease duration and low or moderate baseline MBDA score are most likely to achieve prolonged disease control after TNFi discontinuation. Netherlands Trial Register NTR3112 , 21 October 2011.

AB - The aim of this study was to identify predictors of prolonged disease control after discontinuation of tumor necrosis factor inhibitor (TNFi) treatment in patients with rheumatoid arthritis (RA). Post-hoc analysis of 439 RA patients (67.3% rheumatoid factor positive) with longstanding RA in remission or with stable low disease activity, randomized to stopping TNFi treatment in the multicenter POET trial. Prolonged acceptable disease control was defined as not restarting TNFi treatment within 12 months after stopping. Baseline demographic and disease-related variables were included in univariate and multivariate logistic regression analysis for identifying predictors of relapse. One year after baseline, 220 patients (50.1%) had not restarted TNFi treatment. Use of an anti-TNF monoclonal antibody (versus a receptor antagonist, OR = 2.41; 95% CI: 1.58\3.67), \10 yrs. disease duration (OR = 2.15; 95% CI: 1.42\3.26) and low or moderate multi-biomarker disease activity (MBDA) scores (OR = 2.00; 95% CI: 1.10\3.64) at baseline were independently predictive of successful TNFi discontinuation (area under the receiver operating characteristic curve = 0.66; 95% CI: 0.61\0.71). Results were similar when using no physician-reported flare as the criterion. TNFi-free survival was significantly different for patient groups based on the number of predictors present, ranging from 21.4% of patients with no predictor present to 66.7% of patients with all three predictors present. Patients using an anti-TNF monoclonal antibody, with shorter disease duration and low or moderate baseline MBDA score are most likely to achieve prolonged disease control after TNFi discontinuation. Netherlands Trial Register NTR3112 , 21 October 2011.

U2 - 10.1186/s41927-019-0071-x

DO - 10.1186/s41927-019-0071-x

M3 - Article

VL - 3

SP - 1

EP - 8

JO - BMC Rheumatology

JF - BMC Rheumatology

SN - 2520-1026

IS - 3

ER -