Maintenance, reduction, or withdrawal of etanercept after treatment with etanercept and methotrexate in patients with moderate rheumatoid arthritis (PRESERVE): a randomised controlled trial

Does Combined Clinical and Ultrasound Assessment Allow Selection of Individuals With Rheumatoid Arthritis for Sustained Reduction of Anti–Tumor Necrosis Factor Therapy?

“…Compared to our results, the PRESERVE (Prospective, Randomized Etanercept Study to Evaluate Reduced Dose Etanercept Combined with MTX Versus Full Dose Etanercept Combined with MTX Versus MTX Alone) Trial (16), reported that 60.2% of patients maintained DAS28 remission (,2.6) following a 50% reduction in the dose of etanercept at 9 months followup. However, our population had significantly longer disease duration (mean 10.5 years versus 6.3 years) and higher disease activity (mean baseline DAS28 5.75 versus 4.4) compared to the PRESERVE participants.…”

“…The cost of anti-TNF therapy is also an important consideration and leads to restrictions on prescribing in many countries (13). These combined factors have encouraged the investigation of the potential for anti-TNF dose reduction or discontinuation strategies for patients achieving clinical remission or low disease activity (LDA) (14)(15)(16).…”

“…Evidence to date suggests that while anti-TNF therapy may be discontinued, at least in the short to medium term for some patients treated early in their disease course (17), stopping anti-TNF in established disease leads to high rates of relapse (16). For this reason it has been suggested that in established disease, dose reduction may be a more realistic approach and can be considered for patients in remission or LDA, either by increasing the interval between doses or reducing the dose administered (9,18).…”

Is it safe to withdraw etanercept in established rheumatoid arthritis after low disease activity achievement?

“…In a randomized controlled trial, Smolen et al [5] assessed whether the response to conventional doses of biologics and background methotrexate in patients with moderately active disease would be sustained after etanercept reduction or withdrawal. Patients aged between 18 and 70 with moderate disease activity, defined as a disease activity score on 28 joints (DAS28) value between 3.2 and 5.1 despite treatment with methotrexate were enrolled and given 50 mg etanercept plus methotrexate every week during an open label period of 36 weeks.…”

Cost-effectiveness of Biological Disease-modifying Antirheumatic Drugs for the Treatment of Rheumatoid Arthritis: Implications for Clinical Practice

“…First, the current biological treatment could be provided more efficiently by dosage reduction in patients whose disease is in remission. Results from several studies suggest that biological treatment can be reduced to a half dose in patients in remission without an increased risk of flare 13,14 . In some patients, biological treatment may even be withdrawn completely 15,16 , although identification of these patients, based on clinical factors, is not yet possible.…”