PMID- 28955495 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20191120 IS - 2056-5933 (Print) IS - 2056-5933 (Electronic) IS - 2056-5933 (Linking) VI - 3 IP - 2 DP - 2017 TI - Sustainability of TNF-blocker tapering in rheumatoid arthritis over 3 years: long-term follow-up of the STRASS (Spacing of TNF-blocker injections in Rheumatoid ArthritiS Study) randomised controlled trial. PG - e000474 LID - 10.1136/rmdopen-2017-000474 [doi] LID - e000474 AB - INTRODUCTION: We have limited data on the sustainability of tumour necrosis factor (TNF)-blocker tapering in rheumatoid arthritis (RA) in remission over the long term in real-life settings. This study aimed to assess the probability of sustained dose reduction of TNF-blockers in an observational 3-year extended follow-up of the Spacing of TNF-blocker injections in Rheumatoid ArthritiS Study (STRASS), a randomised controlled trial comparing progressive TNF-blocker injections (spacing arm (S-arm) to maintenance arm (M-arm)) in patients with RA in stable remission. METHODS: In 2015, clinical data for the completer population were retrospectively collected at 1, 2 and 3 years after the end of the trial. The endpoints were the proportion of patients free of a biological disease-modifying antirheumatic drug (bDMARD) treatment, a sustainably spaced injection of TNF-blockers and a full-dose regimen as well as the mean dose of bDMARD intake and treatment switch rate. RESULTS: Overall, 96 patients (76.8% of the completers) had data available up to 3 years; 11.5% discontinued TNF-blockers (5.8% vs 18.2% in the M-arm and S-arm, p=0.06), 30.2% had a tapered regimen (28.8% vs 31.8%, p=0.76) and 37.5% retained a full dose (44.2% vs 29.5%, p=0.14). The mean TNF-blocker dose quotient was 66% of the full dose (74% vs 58% in the M-arm and S-arm, p=0.06); 20.8% switched to another bDMARD (21.2% vs 20.5%, p=0.94). CONCLUSION: Sustained TNF-blocker de-escalation or withdrawal is achievable in 41% of patients over 3 years with limited dose reduction. Optimal strategies remain to be determined to maintain remission after TNF-blocker tapering or discontinuation. FAU - Sigaux, Johanna AU - Sigaux J AD - AP-HP, Department of Rheumatology, IMIDIATE Clinical Research Network, Pitie Salpetriere Hospital, Paris, France. FAU - Bailly, Florian AU - Bailly F AD - AP-HP, Department of Rheumatology, IMIDIATE Clinical Research Network, Pitie Salpetriere Hospital, Paris, France. AD - AP-HP, Department of Pain Clinic, Pitie Salpetriere Hospital, Paris, France. FAU - Hajage, David AU - Hajage D AD - AP-HP, Departement de Biostatistiques, Sante Publique et Information Medicale, Pitie Salpetriere Hospital, Paris, France. AD - AP-HP, Centre de Pharmaco-epidemiologie (Cephepi), Pitie Salpetriere Hospital, Paris, France. AD - University Paris Diderot, Sorbonne Paris Cite, UMR 1123 ECEVE, Paris, France. FAU - Mariette, Xavier AU - Mariette X AD - Paris Sud University, Le Kremlin Bicetre, France. AD - AP-HP, Department of Rheumatology, Bicetre Hospital, Le Kremlin Bicetre, France. FAU - Morel, Jacques AU - Morel J AD - Department of Rheumatology, Montpellier University, Lapeyronie Hospital, Montpellier, France. FAU - Gandjbakhch, Frederique AU - Gandjbakhch F AD - AP-HP, Department of Rheumatology, IMIDIATE Clinical Research Network, Pitie Salpetriere Hospital, Paris, France. AD - Pierre et Marie Curie University, Paris 6, Sorbonne University, GRC-08 (EEMOIS), Paris, France. FAU - Foltz, Violaine AU - Foltz V AD - AP-HP, Department of Rheumatology, IMIDIATE Clinical Research Network, Pitie Salpetriere Hospital, Paris, France. AD - Pierre et Marie Curie University, Paris 6, Sorbonne University, GRC-08 (EEMOIS), Paris, France. FAU - Gossec, Laure AU - Gossec L AD - AP-HP, Department of Rheumatology, IMIDIATE Clinical Research Network, Pitie Salpetriere Hospital, Paris, France. AD - Pierre et Marie Curie University, Paris 6, Sorbonne University, GRC-08 (EEMOIS), Paris, France. FAU - Tubach, Florence AU - Tubach F AD - AP-HP, Department of Rheumatology, IMIDIATE Clinical Research Network, Pitie Salpetriere Hospital, Paris, France. AD - AP-HP, Departement de Biostatistiques, Sante Publique et Information Medicale, Pitie Salpetriere Hospital, Paris, France. AD - AP-HP, Centre de Pharmaco-epidemiologie (Cephepi), Pitie Salpetriere Hospital, Paris, France. FAU - Fautrel, Bruno AU - Fautrel B AD - AP-HP, Department of Rheumatology, IMIDIATE Clinical Research Network, Pitie Salpetriere Hospital, Paris, France. AD - Pierre et Marie Curie University, Paris 6, Sorbonne University, GRC-08 (EEMOIS), Paris, France. LA - eng PT - Journal Article DEP - 20170912 PL - England TA - RMD Open JT - RMD open JID - 101662038 PMC - PMC5604723 OTO - NOTNLM OT - Anti-tnf OT - Rheumatoid Arthritis OT - Treatment COIS- Competing interests: The authors declare a potential conflict of interest having received grant support and/or honoraria for consultations and/or for presentations as indicated: JS: BMS, MSD; XM: BMS, Celgene, GSK, Lilly, MSD, Novartis, Pfizer, Sanofi, UCB; JM: Abbvie, Pfizer, MSD, UCB; FT: research grants from Abbvie, Pfizer, Janssen, MSD, AstraZeneca, Lundbeck; LG: Abbvie, BMS, CelgA ne, Chugai, Janssen, MSD, Novartis, Pfizer, Roche, UCB; BF: AbbVie, BMS, CelgA ne, Hospira, Janssen, Lilly, MSD, Nordic, Novartis, Pfizer, R-Pharm, Roche-Chugai, UCB. EDAT- 2017/09/29 06:00 MHDA- 2017/09/29 06:01 PMCR- 2017/09/12 CRDT- 2017/09/29 06:00 PHST- 2017/04/03 00:00 [received] PHST- 2017/07/18 00:00 [revised] PHST- 2017/08/02 00:00 [accepted] PHST- 2017/09/29 06:00 [entrez] PHST- 2017/09/29 06:00 [pubmed] PHST- 2017/09/29 06:01 [medline] PHST- 2017/09/12 00:00 [pmc-release] AID - rmdopen-2017-000474 [pii] AID - 10.1136/rmdopen-2017-000474 [doi] PST - epublish SO - RMD Open. 2017 Sep 12;3(2):e000474. doi: 10.1136/rmdopen-2017-000474. eCollection 2017.