PT  - JOURNAL ARTICLE
AU  - Kazuki Yoshida
AU  - Helga Radner
AU  - Maria D.  Mjaavatten
AU  - Jeffrey D.  Greenberg
AU  - Arthur Kavanaugh
AU  - Mitsumasa Kishimoto
AU  - Kazuo Matsui
AU  - Masato Okada
AU  - George Reed
AU  - Yukihiko Saeki
AU  - Shigeto Tohma
AU  - Joel Kremer
AU  - Daniel H.  Solomon
TI  - Incidence and Predictors of Biological Antirheumatic Drug Discontinuation Attempts among Patients with Rheumatoid Arthritis in Remission: A CORRONA and NinJa Collaborative Cohort Study
AID  - 10.3899/jrheum.150240
DP  - 2015 Nov 01
TA  - The Journal of Rheumatology
PG  - jrheum.150240
4099  - http://www.jrheum.org/content/early/2015/10/23/jrheum.150240.short
4100  - http://www.jrheum.org/content/early/2015/10/23/jrheum.150240.full
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.