This study examined the effects of withdrawing biologic drugs upon remission in established long-term RA patients.

Rheumatoid arthritis (RA) is an inflammatory disease affecting the joints, the connections between bones. The main focus of RA treatment is to reduce pain and inflammation, and to limit the amount of joint damage. The times when the disease is active and symptomatic are known as flares, and times when the symptoms have reduced or disappeared are known as remission.

There are multiple combinations of drug therapies available, including disease-modifying anti-rheumatic drugs (DMARDs) (Rheumatrex, Trexall), and TNF inhibitors, also known as biologics (Enbrel, Humira). However, TNF inhibitors can interfere with the immune system, reducing the body’s ability to fight infections, and so discontinuation may be desirable. 

This study involved 197 RA patients. They were treated with adalimumab (Humira) and methotrexate (Theumatrex, Trexall). 75 patients were given the option to discontinue Humira treatment, because they went in to remission for more than 6 months. 52 patients agreed to stop taking Humira, 23 preferred to keep taking it.

After 1 year, flares occurred in 52% of patients who stopped taking Humira, compared to 17% in those who continued to take it. However, in a small subset of patients who had “deep remission” i.e. they had extremely reduced symptoms, withdrawing Humira treatment resulted in a 32% flare rate compared to 8% in those who kept taking the drug. For those who experienced flares after Humira withdrawal, returning to Humira treatment successfully reduced RA symptoms again in 100% of patients. 

This study showed that withdrawing Humira treatment might be beneficial for some RA patients, but not all. 

The number of patients in this study was small, more studies will be needed to confirm the results. The authors have received funding by the manufacturers of Humira in the past.