Is tapering or discontinuation of TNF inhibitors possible?

Abstract

  With the introduction of conventional disease-modifying anti rheumatic drugs（csDMARDs）, especially methotrexate（MTX）and biological DMARDs（bDMARDs）, the disease activity of rheumatoid arthritis can be dramatically improved. However, the medical cost of bDMARDs is a big problem for both patients and the national medical system. A few studies have examined the effect of the discontinuation of anti-TNF antibodies, such as the BeST, RRR, and BuSHIDO studies for infliximab; the HONOR, HIT HARD, OPTIMA, and HOPEFUL-2, 3 studies for adalimumab（ADA）; and the CERTAIN and C-OPERA studies for certolizumab-pegol（CZP）. The PRESERVE and ENCOURAGE studies explored the effects of the tapering and discontinuation of the soluble TNF receptor, etanercept（ETN）. In order to achieve a so-called “Bio-free condition”, the early introduction of bDMARDs is desirable. We used ADA within 3 months of MTX introduction in 39 patients and obtained good results even though there was 1 anti-TNF non-responder who was rescued by tocilizumab. A Bio-free condition can still be achieved with the early introduction of bDMARDs, even those without cytotoxicity, such as ETN and CZP.