Abstract
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.
- RHEUMATOID ARTHRITIS
- ANTIRHEUMATIC AGENTS
- AFFILIATIONS
- BIOLOGICAL ANTIRHEUMATIC AGENTS
- REMISSION
- DISCONTINUATION
Footnotes
The CORRONA Rheumatoid Arthritis registry has been supported through contracted subscriptions in the last 2 years by Abbvie, Amgen, AstraZeneca, Genentech, Horizon Pharma, Eli Lilly, Novartis, Pfizer, Vertex, and UCB. This study was conducted entirely independently of any pharmaceutical company input. NinJa has been supported in part by a Health and Labor Sciences Research Grant from the Ministry of Health, Labor, and Welfare of Japan. KY receives tuition support jointly from Japan Student Services Organization and Harvard T.H. Chan School of Public Health (partially supported by training grants from Pfizer, Takeda, Bayer, and PhRMA). JDG is an employee and shareholder of CORRONA. He has received consulting fees from AstraZeneca and Pfizer. AK has conducted sponsored clinical research for Amgen and UCB. MK received speaking fees and/or honoraria from Pfizer. MO received speaking fees and/or honoraria from Pfizer. GR is an employee of CORRONA. ST received research grants from Pfizer Japan Inc. JK received research grants from Amgen, Genentech, Pfizer, and UCB. He owns shares in CORRONA and derives salary support. DHS receives salary support from institutional research grants from Eli Lilly, Amgen, and CORRONA. He also serves in unpaid roles in studies funded by Pfizer and Eli Lilly, and receives salary support from NIH-K24AR055989.
- Accepted for publication August 11, 2015.