Can low disease activity be maintained in early rheumatoid arthritis without adalimumab?

This study investigated if low disease activity could be maintained in early rheumatoid arthritis following discontinuation of long-term adalimumab.

They found that the majority of patients that discontinued adalimumab maintained low disease activity after 3 years.

Rheumatoid arthritis is an autoimmune disease where the body’s immune system attacks healthy joint tissue and causes irreversible damage. Treatment strategies aim to reduce the immune response. Standard first line treatment for many patients is methotrexate (MTX). This medication suppresses the immune system via multiple targets. Adalimumab (ADA) is a drug that inhibits the action of tumor necrosis factor (TNF), which is pro-inflammatory.

Studies suggest combining ADA and MTX is a more effective treatment approach for early RA. Long-term use of ADA carries the risk of serious infection due to immune system suppression. This study investigated if discontinuing ADA treatment would allow for maintenance of low disease activity (LDA) in patients with early RA.

172 patients were included in the study. This was an observational study; the data from two groups of patients, those that continued ADA (40 mg) + MTX treatment and those who discontinued ADA (MTX alone), were examined.  All patients had LDA at the beginning of this trial. Follow-up assessment was performed after 208 weeks.

After 3 years, 80% of patients in the ADA discontinuation group maintained LDA. After 4 years, 80% of ADA discontinuation patients maintained LDA compared to 95% of ADA continuation patients. Further analysis identified that patients with disease activity scores based on C-reactive protein and rheumatoid factor at week 52 were less likely to maintain LDA without ADA treatment. 

9.7% of the ADA discontinuation group experienced negative effects, compared to 32.9% of the ADA continuation group. Infections were the most common reported event.

This study concluded that adalimumab discontinuation does not alter LDA in early RA patients.

The majority of patients were female (more than 85%).  One third of patients who discontinued ADA did not maintain LDA. Factors such such as C-reactive protein and rheumatoid factor may predict this. 

If you have concerns regarding treatment for early RA please discuss with your doctor.