Abstract
We reviewed ten patients with rheumatoid arthritis who were able to discontinue treatment with biologic agents after achieving clinical remission. The decision to discontinue treatment was made on the basis of a DAS28-CRP value below 2.0 and a MMP-3 improvement ratio of less than 0.4 for more than six months. Seven patients who were receiving infliximab, two receiving adalimumab, and one receiving etanercept discontinued their treatments, among whom six and one who had been receiving infliximab and adalimumab, respectively, were subsequently maintained successfully without re-introduction of the treatment. One patient who had been receiving infliximab has remained in remission without any drug treatment. However, one patient who had been receiving etanercept needed to re-start the treatment because of flare-up of the disease activity three years after discontinuation, while another patient who had been receiving infliximab needed to start golimumab twenty-one months after discontinuation, and one who had been receiving adalimumab also needed to start abatacept just six months after discontinuation. In order to maintain clinical remission after discontinuation of biologic agents, monitoring of indices such as DAS28 and MMP-3 is insufficient, and careful attention to disease activity is also important.
