RT Journal Article
SR Electronic
T1 Incidence and Predictors of Biological Antirheumatic Drug Discontinuation Attempts among Patients with Rheumatoid Arthritis in Remission: A CORRONA and NinJa Collaborative Cohort Study
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP 2238
OP 2246
DO 10.3899/jrheum.150240
VO 42
IS 12
A1 Kazuki Yoshida
A1 Helga Radner
A1 Maria D. Mjaavatten
A1 Jeffrey D. Greenberg
A1 Arthur Kavanaugh
A1 Mitsumasa Kishimoto
A1 Kazuo Matsui
A1 Masato Okada
A1 George Reed
A1 Yukihiko Saeki
A1 Shigeto Tohma
A1 Joel Kremer
A1 Daniel H. Solomon
YR 2015
UL http://www.jrheum.org/content/42/12/2238.abstract
AB Objective. We conducted a longitudinal observational study of biological disease-modifying antirheumatic drugs (bDMARD) to describe the proportions of patients with rheumatoid arthritis in remission who discontinued these agents, and to assess the potential predictors of the decision to discontinue.Methods. We used data from the US COnsortium of Rheumatology Researchers Of North America (CORRONA) and the Japanese National Database of Rheumatic Diseases by iR-net in Japan (NinJa) registries, and ran parallel analyses. Patients treated with bDMARD who experienced remission (defined by the Clinical Disease Activity Index ≤ 2.8) were included. The outcome of interest was the occurrence of bDMARD discontinuation while in remission. The predictors of discontinuation were assessed in the Cox regression models. Frailty models were also used to examine the effects of individual physicians in the discontinuation decision.Results. The numbers of eligible patients who were initially in remission were 6263 in the CORRONA and 744 in the NinJa. Among these patients, 10.0% of patients in CORRONA and 11.8% of patients in NinJa discontinued bDMARD while in remission over 5 years, whereas many of the remaining patients lost remission before discontinuing bDMARD. Shorter disease duration was associated with higher rates of discontinuation in both cohorts. In CORRONA, methotrexate use and lower disease activity were also associated with discontinuation. In frailty models, physician random effects were significant in both cohorts.Conclusion. Among patients who initially experienced remission while receiving bDMARD, around 10% remained in remission and then discontinued bDMARD in both registries. Several factors were associated with more frequent discontinuation while in remission. Physician preference likely is also an important correlate of bDMARD discontinuation, indicating the need for standardization of practice.