Abstract
Background: Tapering or stopping biological disease-modifying anti-rheumatic drugs has been proposed for patients with rheumatoid arthritis (RA) in remission, but it frequently results in high rates of recurrence. This study evaluates the efficacy and safety of tacrolimus (TAC) as maintenance therapy in patients with established RA in remission after receiving combination therapy with tumor necrosis factor inhibitor (TNFi) and methotrexate (MTX). Methods: This 24-week, prospective, open-label trial included patients who received TNFi and MTX at stable doses for ≥24 weeks and had low disease activity (LDA), measured by Disease Activity Score-28 for ≥12 weeks. Patients selected one of two arms: maintenance (TNFi plus MTX) or switched (TAC plus MTX). The primary outcome was the difference in the proportion of patients maintaining LDA at week 24, which was assessed using a logistic regression model. Adverse events were monitored throughout the study period. Results: In efficacy analysis, 80 and 34 patients were included in the maintenance and switched arms, respectively. At week 24, LDA was maintained in 99% and 91% of patients in the maintenance and switched arms, respectively (odds ratio, 0.14; 95% confidence interval, 0.01–1.59). Drug-related adverse effects tended to be more common in the switched arm than in the maintenance arm (20.9% versus 7.1%, respectively) but were well-tolerated. Conclusion: This controlled study tested a novel treatment strategy of switching from TNFi to TAC in RA patients with sustained LDA, and the findings suggested that TNFi can be replaced with TAC in most patients without the patients experiencing flare-ups for at least 24 weeks. Trial registration: Korea CDC CRIS, KCT0005868. Registered 4 February 2021—retrospectively registered.
Original language | English |
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Article number | 182 |
Journal | Arthritis Research and Therapy |
Volume | 23 |
Issue number | 1 |
DOIs | |
State | Published - Dec 2021 |
Bibliographical note
Funding Information:The trial was supported by Astellas Pharma Korea, Inc. (Seoul, Korea). The sponsor was not involved in the study design or data analysis. Interpretation of data and publication of the study results were not contingent on the sponsor’s approval or censorship of the manuscript.
Publisher Copyright:
© 2021, The Author(s).
Keywords
- Low disease activity
- Maintenance
- Rheumatoid arthritis
- Tacrolimus
- Tumor necrosis factor inhibitors