PMID- 28692770
OWN - NLM
STAT- MEDLINE
DCOM- 20190107
LR  - 20190107
IS  - 2151-4658 (Electronic)
IS  - 2151-464X (Linking)
VI  - 70
IP  - 4
DP  - 2018 Apr
TI  - Impact of Stopping Tumor Necrosis Factor Inhibitors on Rheumatoid Arthritis 
      Patients' Burden of Disease.
PG  - 516-524
LID - 10.1002/acr.23315 [doi]
AB  - OBJECTIVE: To determine the impact of stopping tumor necrosis factor inhibitor 
      (TNFi) treatment on patient-reported outcomes (PROs) of physical and mental 
      health status, health utility, pain, disability, and fatigue in patients with 
      established rheumatoid arthritis (RA). METHODS: In the pragmatic, 12-month POET 
      trial, 817 RA patients with >/=6 months of remission or stable low disease activity 
      were randomized 2:1 to stopping or continuing TNFi. In case of flare, TNFi was 
      restarted at the discretion of the rheumatologist. PROs were assessed every 3 
      months. RESULTS: TNFi was restarted within 12 months in 252 of 531 patients 
      (47.5%) in the stop group. At 3 months, mean PRO scores were significantly worse 
      in the stop group, and a larger proportion of patients experienced a minimum 
      clinically important difference (MCID) on all PROs. Effect sizes (ES) were 
      strongest for health utility (ES -0.24) and pain (ES -0.30). Mean scores improved 
      again after this point, but disability scores remained significantly different at 
      12 months. After 12 months, the relative risk of experiencing an MCID ranged from 
      1.16 for mental health status to 1.58 for fatigue. Mean PRO scores for patients 
      restarting TNFi within 6 months were no longer significantly different from those 
      that did not restart TNFi at 12 months. CONCLUSION: Stopping TNFi had a 
      significant negative short-term impact on a broad range of PROs. Long-term 
      negative consequences appeared to be limited, and outcomes in patients needing to 
      restart TNFi within the first 6 months tended to be restored at 12 months.
CI  - (c) 2017, American College of Rheumatology.
FAU - Ghiti Moghadam, Marjan
AU  - Ghiti Moghadam M
AD  - Arthritis Centre Twente, University of Twente, and Medisch Spectrum Twente, 
      Enschede, The Netherlands.
FAU - Ten Klooster, Peter M
AU  - Ten Klooster PM
AD  - Arthritis Centre Twente, University of Twente, and Medisch Spectrum Twente, 
      Enschede, The Netherlands.
FAU - Vonkeman, Harald E
AU  - Vonkeman HE
AD  - Arthritis Centre Twente, University of Twente, and Medisch Spectrum Twente, 
      Enschede, The Netherlands.
FAU - Kneepkens, Eva L
AU  - Kneepkens EL
AD  - Reade, Amsterdam, The Netherlands.
FAU - Klaasen, Ruth
AU  - Klaasen R
AD  - Meander Medical Centre, Amersfoort, The Netherlands.
FAU - Stolk, Jan N
AU  - Stolk JN
AD  - Gelderse Vallei Hospital, Ede, The Netherlands.
FAU - Tchetverikov, Ilja
AU  - Tchetverikov I
AD  - Albert Schweitzer Hospital, Dordrecht, The Netherlands.
FAU - Vreugdenhil, Simone A
AU  - Vreugdenhil SA
AD  - St. Antonius Hospital, Nieuwegein, The Netherlands.
FAU - van Woerkom, Jan M
AU  - van Woerkom JM
AD  - Gelre Hospitals, Apeldoorn, The Netherlands.
FAU - Goekoop-Ruiterman, Yvonne P M
AU  - Goekoop-Ruiterman YPM
AD  - Haga Hospital, The Hague, The Netherlands.
FAU - Landewe, Robert B M
AU  - Landewe RBM
AD  - Academic Medical Center, Amsterdam, The Netherlands.
FAU - van Riel, Piet L C M
AU  - van Riel PLCM
AD  - Radboud University Medical Center, Nijmegen, The Netherlands.
FAU - van de Laar, Mart A F J
AU  - van de Laar MAFJ
AD  - Arthritis Centre Twente, University of Twente, and Medisch Spectrum Twente, 
      Enschede, The Netherlands.
FAU - Jansen, Tim L
AU  - Jansen TL
AD  - VieCuri Medical Center, Venlo, The Netherlands.
CN  - Dutch National POET Collaboration
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Multicenter Study
PT  - Pragmatic Clinical Trial
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Arthritis Care Res (Hoboken)
JT  - Arthritis care & research
JID - 101518086
RN  - 0 (Antirheumatic Agents)
RN  - 0 (Biological Products)
RN  - 0 (Tumor Necrosis Factor-alpha)
SB  - IM
MH  - Aged
MH  - Antirheumatic Agents/*administration & dosage
MH  - Arthritis, Rheumatoid/*drug therapy/immunology/physiopathology/psychology
MH  - Biological Products/*administration & dosage
MH  - *Cost of Illness
MH  - Disability Evaluation
MH  - Drug Administration Schedule
MH  - Female
MH  - Health Status
MH  - Humans
MH  - Male
MH  - Mental Health
MH  - Middle Aged
MH  - Netherlands
MH  - Pain Measurement
MH  - Patient Reported Outcome Measures
MH  - Recurrence
MH  - Remission Induction
MH  - Time Factors
MH  - Treatment Outcome
MH  - Tumor Necrosis Factor-alpha/*antagonists & inhibitors/immunology
EDAT- 2017/07/12 06:00
MHDA- 2019/01/08 06:00
CRDT- 2017/07/11 06:00
PHST- 2017/02/07 00:00 [received]
PHST- 2017/07/06 00:00 [accepted]
PHST- 2017/07/12 06:00 [pubmed]
PHST- 2019/01/08 06:00 [medline]
PHST- 2017/07/11 06:00 [entrez]
AID - 10.1002/acr.23315 [doi]
PST - ppublish
SO  - Arthritis Care Res (Hoboken). 2018 Apr;70(4):516-524. doi: 10.1002/acr.23315.