Discontinuation of adalimumab after achieving remission in patients with established rheumatoid arthritis: 1-year outcome of the HONOR study

Yoshiya Tanaka, Shintaro Hirata, Satoshi Kubo, Shunsuke Fukuyo, Kentaro Hanami, Norifumi Sawamukai, Kazuhisa Nakano, Shingo Nakayamada, Kunihiro Yamaoka, Fusae Sawamura, Kazuyoshi Saito

Research output: Contribution to journalArticle

98 Citations (Scopus)

Abstract

Objectives: To investigate the possibility of discontinuing adalimumab (ADA) for 1 year without flaring (DAS28-erythrocyte sedimentation rate (ESR) ≥3.2), and to identify factors enabling established patients with rheumatoid arthritis (RA) to remain ADA-free. Methods: Of 197 RA patients treated with ADA +methotrexate (MTX), 75 patients who met the ADA-free criteria (steroid-free and sustained DAS28-ESR remission for 6 months with stable MTX doses) were studied for 1 year. Results: The mean disease duration and DAS28-ESR score in 75 patients was 7.5 years and 5.1 at baseline, respectively. The proportion of patients who sustained DAS28-ESR <2.6 (48%) and DAS28-ESR <3.2 (62%) for 1 year were significantly lower in the ADA discontinuation group than in the ADA continuation group; however, in patients with deep remission (DAS28-ESR ≤1.98) identified by receiver operating characteristics analysis following logistic analysis, these rates increased to 68% and 79%, respectively, with no significant difference between both groups. Remarkably, ADA readministration to patients with flare was effective in returning DAS28-ESR to <3.2 within 6 months in 90% and 9 months in 100% patients; among the patients who sustained DAS28-ESR <3.2 during ADA discontinuation, 100% remained in structural remission and 94% in functional remission. Conclusions: The possibility of remaining ADA-free for 1 year was demonstrated in established patients with RA with outcomes that ADA can be discontinued without flaring in 79% patients with deep remission, with similar rates in the ADA continuation group, and showed no functional or structural damage in patients with DAS28-ESR <3.2. ADA readministration to patients with flare during ADA discontinuation was effective.

Original languageEnglish
Pages (from-to)389-395
Number of pages7
JournalAnnals of the Rheumatic Diseases
Volume74
Issue number2
DOIs
Publication statusPublished - 2015 Feb 1
Externally publishedYes

Fingerprint

Rheumatoid Arthritis
Blood Sedimentation
Outcome Assessment (Health Care)
Sedimentation
Methotrexate
Adalimumab
ROC Curve
Causality
Logistics
Steroids

ASJC Scopus subject areas

  • Rheumatology
  • Immunology
  • Biochemistry, Genetics and Molecular Biology(all)
  • Immunology and Allergy

Cite this

Discontinuation of adalimumab after achieving remission in patients with established rheumatoid arthritis : 1-year outcome of the HONOR study. / Tanaka, Yoshiya; Hirata, Shintaro; Kubo, Satoshi; Fukuyo, Shunsuke; Hanami, Kentaro; Sawamukai, Norifumi; Nakano, Kazuhisa; Nakayamada, Shingo; Yamaoka, Kunihiro; Sawamura, Fusae; Saito, Kazuyoshi.

In: Annals of the Rheumatic Diseases, Vol. 74, No. 2, 01.02.2015, p. 389-395.

Research output: Contribution to journalArticle

Tanaka, Y, Hirata, S, Kubo, S, Fukuyo, S, Hanami, K, Sawamukai, N, Nakano, K, Nakayamada, S, Yamaoka, K, Sawamura, F & Saito, K 2015, 'Discontinuation of adalimumab after achieving remission in patients with established rheumatoid arthritis: 1-year outcome of the HONOR study', Annals of the Rheumatic Diseases, vol. 74, no. 2, pp. 389-395. https://doi.org/10.1136/annrheumdis-2013-204016
Tanaka, Yoshiya ; Hirata, Shintaro ; Kubo, Satoshi ; Fukuyo, Shunsuke ; Hanami, Kentaro ; Sawamukai, Norifumi ; Nakano, Kazuhisa ; Nakayamada, Shingo ; Yamaoka, Kunihiro ; Sawamura, Fusae ; Saito, Kazuyoshi. / Discontinuation of adalimumab after achieving remission in patients with established rheumatoid arthritis : 1-year outcome of the HONOR study. In: Annals of the Rheumatic Diseases. 2015 ; Vol. 74, No. 2. pp. 389-395.
@article{4ad085719e4e44868ecbdf4da178e424,
title = "Discontinuation of adalimumab after achieving remission in patients with established rheumatoid arthritis: 1-year outcome of the HONOR study",
abstract = "Objectives: To investigate the possibility of discontinuing adalimumab (ADA) for 1 year without flaring (DAS28-erythrocyte sedimentation rate (ESR) ≥3.2), and to identify factors enabling established patients with rheumatoid arthritis (RA) to remain ADA-free. Methods: Of 197 RA patients treated with ADA +methotrexate (MTX), 75 patients who met the ADA-free criteria (steroid-free and sustained DAS28-ESR remission for 6 months with stable MTX doses) were studied for 1 year. Results: The mean disease duration and DAS28-ESR score in 75 patients was 7.5 years and 5.1 at baseline, respectively. The proportion of patients who sustained DAS28-ESR <2.6 (48{\%}) and DAS28-ESR <3.2 (62{\%}) for 1 year were significantly lower in the ADA discontinuation group than in the ADA continuation group; however, in patients with deep remission (DAS28-ESR ≤1.98) identified by receiver operating characteristics analysis following logistic analysis, these rates increased to 68{\%} and 79{\%}, respectively, with no significant difference between both groups. Remarkably, ADA readministration to patients with flare was effective in returning DAS28-ESR to <3.2 within 6 months in 90{\%} and 9 months in 100{\%} patients; among the patients who sustained DAS28-ESR <3.2 during ADA discontinuation, 100{\%} remained in structural remission and 94{\%} in functional remission. Conclusions: The possibility of remaining ADA-free for 1 year was demonstrated in established patients with RA with outcomes that ADA can be discontinued without flaring in 79{\%} patients with deep remission, with similar rates in the ADA continuation group, and showed no functional or structural damage in patients with DAS28-ESR <3.2. ADA readministration to patients with flare during ADA discontinuation was effective.",
author = "Yoshiya Tanaka and Shintaro Hirata and Satoshi Kubo and Shunsuke Fukuyo and Kentaro Hanami and Norifumi Sawamukai and Kazuhisa Nakano and Shingo Nakayamada and Kunihiro Yamaoka and Fusae Sawamura and Kazuyoshi Saito",
year = "2015",
month = "2",
day = "1",
doi = "10.1136/annrheumdis-2013-204016",
language = "English",
volume = "74",
pages = "389--395",
journal = "Annals of the Rheumatic Diseases",
issn = "0003-4967",
publisher = "BMJ Publishing Group",
number = "2",

}

TY - JOUR

T1 - Discontinuation of adalimumab after achieving remission in patients with established rheumatoid arthritis

T2 - 1-year outcome of the HONOR study

AU - Tanaka, Yoshiya

AU - Hirata, Shintaro

AU - Kubo, Satoshi

AU - Fukuyo, Shunsuke

AU - Hanami, Kentaro

AU - Sawamukai, Norifumi

AU - Nakano, Kazuhisa

AU - Nakayamada, Shingo

AU - Yamaoka, Kunihiro

AU - Sawamura, Fusae

AU - Saito, Kazuyoshi

PY - 2015/2/1

Y1 - 2015/2/1

N2 - Objectives: To investigate the possibility of discontinuing adalimumab (ADA) for 1 year without flaring (DAS28-erythrocyte sedimentation rate (ESR) ≥3.2), and to identify factors enabling established patients with rheumatoid arthritis (RA) to remain ADA-free. Methods: Of 197 RA patients treated with ADA +methotrexate (MTX), 75 patients who met the ADA-free criteria (steroid-free and sustained DAS28-ESR remission for 6 months with stable MTX doses) were studied for 1 year. Results: The mean disease duration and DAS28-ESR score in 75 patients was 7.5 years and 5.1 at baseline, respectively. The proportion of patients who sustained DAS28-ESR <2.6 (48%) and DAS28-ESR <3.2 (62%) for 1 year were significantly lower in the ADA discontinuation group than in the ADA continuation group; however, in patients with deep remission (DAS28-ESR ≤1.98) identified by receiver operating characteristics analysis following logistic analysis, these rates increased to 68% and 79%, respectively, with no significant difference between both groups. Remarkably, ADA readministration to patients with flare was effective in returning DAS28-ESR to <3.2 within 6 months in 90% and 9 months in 100% patients; among the patients who sustained DAS28-ESR <3.2 during ADA discontinuation, 100% remained in structural remission and 94% in functional remission. Conclusions: The possibility of remaining ADA-free for 1 year was demonstrated in established patients with RA with outcomes that ADA can be discontinued without flaring in 79% patients with deep remission, with similar rates in the ADA continuation group, and showed no functional or structural damage in patients with DAS28-ESR <3.2. ADA readministration to patients with flare during ADA discontinuation was effective.

AB - Objectives: To investigate the possibility of discontinuing adalimumab (ADA) for 1 year without flaring (DAS28-erythrocyte sedimentation rate (ESR) ≥3.2), and to identify factors enabling established patients with rheumatoid arthritis (RA) to remain ADA-free. Methods: Of 197 RA patients treated with ADA +methotrexate (MTX), 75 patients who met the ADA-free criteria (steroid-free and sustained DAS28-ESR remission for 6 months with stable MTX doses) were studied for 1 year. Results: The mean disease duration and DAS28-ESR score in 75 patients was 7.5 years and 5.1 at baseline, respectively. The proportion of patients who sustained DAS28-ESR <2.6 (48%) and DAS28-ESR <3.2 (62%) for 1 year were significantly lower in the ADA discontinuation group than in the ADA continuation group; however, in patients with deep remission (DAS28-ESR ≤1.98) identified by receiver operating characteristics analysis following logistic analysis, these rates increased to 68% and 79%, respectively, with no significant difference between both groups. Remarkably, ADA readministration to patients with flare was effective in returning DAS28-ESR to <3.2 within 6 months in 90% and 9 months in 100% patients; among the patients who sustained DAS28-ESR <3.2 during ADA discontinuation, 100% remained in structural remission and 94% in functional remission. Conclusions: The possibility of remaining ADA-free for 1 year was demonstrated in established patients with RA with outcomes that ADA can be discontinued without flaring in 79% patients with deep remission, with similar rates in the ADA continuation group, and showed no functional or structural damage in patients with DAS28-ESR <3.2. ADA readministration to patients with flare during ADA discontinuation was effective.

UR - http://www.scopus.com/inward/record.url?scp=84921295252&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84921295252&partnerID=8YFLogxK

U2 - 10.1136/annrheumdis-2013-204016

DO - 10.1136/annrheumdis-2013-204016

M3 - Article

C2 - 24288014

AN - SCOPUS:84921295252

VL - 74

SP - 389

EP - 395

JO - Annals of the Rheumatic Diseases

JF - Annals of the Rheumatic Diseases

SN - 0003-4967

IS - 2

ER -