Refining IFX doses does not facilitate sustained remission after treatment discontinuation

A programmed treatment strategy of refining infliximab (IFX) doses based on baseline serum tumour necrosis factor α (TNF-α) falls flat in sustaining remission rate in rheumatoid arthritis patients after 1 year of IFX discontinuation, according to the results of the multicentre randomized RRRR* trial.

RRRR included 337 IFX-naïve rheumatoid arthritis patients with inadequate response to methotrexate (MTX). Of these patients, 170 were assigned to the programmed treatment group that received 3 mg/kg of IFX until week 6. After 14 weeks, the dose was adjusted based on baseline serum TNF-α levels until week 54. The remaining 167 patients were assigned to the standard treatment group that received 3 mg/kg of IFX.

Sixty-seven patients (39.4 percent) in the programmed group and 54 (32.3 percent) in the standard group achieved remission at week 54 and discontinued IFX treatment. There was no significant between-group difference in the primary endpoint of sustained remission off IFX treatment at week 106: 23.5 percent vs 21.6 percent, respectively (difference, 2.2 percent, 95 percent confidence interval [CI], −6.6 percent to 11.0 percent; p=0.631).

Baseline SDAI <26.0 emerged as a significant predictor of successfully sustained discontinuation of IFX at week 106.

The findings indicate that a programmed treatment strategy does not guarantee a favourable outcome in terms of deep remission. Researchers called for additional investigation to pinpoint the patient profile most likely to benefit from discontinuation of biological disease-modifying antirheumatic drugs.

*Remission induction by raising the dose of remicade in RA