• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar
  • Skip to footer

Johns Hopkins Arthritis Center

Show Search
Hide Search
  • Disease Information
    • Rheumatoid Arthritis
    • Psoriatic Arthritis
    • Ankylosing Spondylitis
    • Osteoarthritis
    • Gout
    • Osteoporosis
  • Patient Corner
    • Drug Information Sheets
    • Managing Your Arthritis
    • RheumTV – Patient Education Video Library
  • Our Research
    • Patient-Centered Outcomes Research
    • Current Research Studies
    • The Camille Julia Morgan Arthritis Research and Education Fund
  • About Us
    • Appointment Information
    • Contact Us
    • Our Faculty
    • Our Staff
    • Rheumatology Specialty Centers
  • Donate
Home / Arthritis News / Does Reinstituting Anti-TNF Therapy Following Relapse in Remission in RA Have Similar Efficacy?

Does Reinstituting Anti-TNF Therapy Following Relapse in Remission in RA Have Similar Efficacy?

April 13, 2005 By Arthritis Center

Approximately one-third to half of patients with established RA will experience deterioration in symptom control in the year following discontinuation of disease-modifying anti-rheumatic drugs (DMARDs). Particularly for older DMARDS, such as parenteral gold and anti-malarials, reinstitution has been suggested to be less effective in controlling RA disease activity. Though this phenomenon is not as well studied for methotrexate and unstudied for newer cytokines inhibitors, there is concern that reinstating an effective DMARD after discontinuation may not achieve the previous level of efficacy. For this reason, DMARDs are generally continued through long periods of symptom-free remission. Here, Buch et al (Rheumatology; 43, 2004: 243) examine relapse of RA after discontinuing infliximab and efficacy after restarting the drug.

Methods: 17 of the 24 subjects enrolled in the ATTRACT (Anti-TNF Therapy in RA with Concomitant Therapy) Trial in Leeds, UK who received infliximab were followed into the extension phase of the trial. In the first two years of the trial, patients with RA were randomized to placebo or 3mg/kg or 10mg/kg doses of infliximab administered every 4 or 8 weeks (comprising four infliximab treatment groups). Methotrexate of at least 12.5 mg per week was continued in all groups and was continued into the extension phase after infliximab therapy was discontinued. At 24 months, infliximab therapy was stopped, and subjects were followed for relapse. At relapse, defined as a 20% or greater deterioration in ACR composite score, subjects were restarted on infliximab at 3mg/kg at standard dosing schedule and reassessed at nine months for change in ACR response.

Results: All 17 patients flared after discontinuation of infliximab. Mean time to flare was between 13.5 to 20 weeks. A statistically non-significant trend in greater time to flare was observed in the two groups previously treated with 10mg/kg of infliximab compared with the two groups previously treated with 3mg/kg of infliximab. 14 of the 17 patients were retreated with at least 9 months of 3 mg/kg of infliximab after relapse. 12 of these 14 achieved comparable ACR-(n) responses on retreatment as observed on nave treatment. The remaining two patients had a less efficacious response on retreatment. No infusion reactions or drug-specific toxicities were noted on retreatment.

Conclusion: Continuation of anti-TNF therapy is required to maintain remission in established RA. Reinstituting therapy after discontinuation and relapse is of comparable efficacy to response in nave subjects.

Editorial Comments: This small study addresses important issues that have not been previously investigated in the context of TNF inhibitors, namely whether continuous TNF therapy is required in TNF responsive patients and whether discontinuous TNF therapy can achieve the same level of efficacy as continuous therapy. This question has practical implications owing to the cost and toxicities related to TNF therapy. Unfortunately, this imperfectly designed and underpowered study cannot reliably support the stated conclusions. Importantly, it is impossible to refute an induction effect with the use of TNF inhibition, since no non-TNF treated patients are included in this extension sub-analysis. In other words, among the members of this subgroup, the two years of initial infliximab may have made latter responses better on retreatment than matched subjects that had not received TNF inhibition during that period. Despite this, these preliminary results are worth noting and suggest areas for further investigation.

Receive the Latest News from Johns Hopkins Rheumatology

Receive the Latest News from Johns Hopkins Rheumatology

Join our mailing list to receive the latest news and updates from Johns Hopkins Rheumatology.

Interested In

You have Successfully Subscribed!

Arthritis Center

Founded in 1998, the Arthritis Center at Johns Hopkins is dedicated to providing quality education to patients and healthcare providers alike.

Use of this Site

All information contained within the Johns Hopkins Arthritis Center website is intended for educational purposes only. Physicians and other health care professionals are encouraged to consult other sources and confirm the information contained within this site. Consumers should never disregard medical advice or delay in seeking it because of something they may have read on this website.

Primary Sidebar

Recent News

Exercise Tips for Arthritis Patients

How Does Exercise Affect my Joints? How Frequently Should I Be Exercising? Should I Lose Weight for Exercise to be

Risks and Benefits of Biologic Medications

Victoria Ruffing, RN, BC, Director of Patient Education at the Johns Hopkins Arthritis Center, shares the risks and benefits of biologic for

How to Manage Rheumatoid Arthritis Flares

Through research, doctors have a clearer understanding of how flares can impact a patient on a personal and emotional level. Dr. Uzma Haque

Complementary & Alternative Medicines for Psoriatic Arthritis

There are many complementary & alternative medicines and practices that have been found to be beneficial in curbing arthritis pain,

I can’t be a runner because I have Rheumatoid Arthritis (RA), right?

Dr. Manno discusses running and Rheumatoid Arthritis. Is it an option for the RA patient?

News Categories

  • Ankylosing Spondylitis News
  • Fibromyalgia News
  • Gout News
  • Lupus News
  • Osteoarthritis News
  • Osteoporosis News
  • Psoriatic Arthritis News
  • Rheumatoid Arthritis News
RheumTV Logo

Rheum.TV is an informational platform created to educate patients living with a rheumatic disease. With over 100 disease education videos produced by the team at Johns Hopkins Rheumatology.

Visit Rheum.TV

Footer

Johns Hopkins Rheumatology

  • Johns Hopkins Rheumatology
  • Johns Hopkins Lupus Center
  • Johns Hopkins Lyme Disease Research Center
  • Johns Hopkins Myositis Center
  • Johns Hopkins Scleroderma Center
  • Johns Hopkins Sjögren’s Syndrome Center
  • Johns Hopkins Vasculitis Center

Connect With Us

  • Facebook
  • Twitter
  • YouTube

Johns Hopkins Medicine

© 2023 Johns Hopkins Arthritis Center
Patient Privacy