The objective of this study was to determine the time to relapse after tumor necrosis factor ⍺ (TNF⍺) antagonist discontinuation in patients with remission of rheumatoid arthritis (RA).

Among 304 patients taking TNF⍺ antagonist therapy for RA, 21 achieved a remission and were taken off the TNF⍺ antagonist. Remission was defined as DAS28<2.6 for at least 6months without nonsteroidal inflammatory drugs or more than 5mg of prednisone per day but with disease-modifying antirheumatic drug (DMARD) therapy if needed. The same TNF⍺ antagonist was restarted in the event of a relapse (DAS28>3.2).

The 21 patients had a mean age of 61years, a mean disease duration of 11.3years, and a mean remission duration at TNF⍺ antagonist discontinuation of 19.2months. The TNF⍺ antagonist was infliximab in 2 patients, adalimumab in 5, and etanercept in 14; and 14 patients were taking a concomitant DMARD. The number of patients still in remission after TNF⍺ antagonist discontinuation was 9/20 after 6months and 5/20 after 12months. Mean time to relapse was 14.7weeks. While off TNF⍺ antagonist therapy, 3 of the 5 relapse-free patients after 12months were on DMARD therapy, compared to 11 of the 15 patients who relapsed. Compared to the 15 patients who relapsed, the 5 relapse-free patients had a longer time on TNF⍺ antagonist therapy (56months vs. 35months, P=0.012) and a longer time in remission on TNF⍺ antagonist therapy (35months vs.14.5months, P=0.04). The 15 patients who relapsed consistently achieved a remission after resuming TNF⍺ antagonist therapy; the remission occurred within 2months in 13 patients.

TNF⍺ antagonist discontinuation in patients in remission of RA was followed by a relapse within 12months in 75% of cases. Relapsing patients responded well to resumption of the same TNF⍺ antagonist.