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Impact of Stopping Tumor Necrosis Factor Inhibitors on Rheumatoid Arthritis Patients' Burden of Disease.
- Source :
-
Arthritis care & research [Arthritis Care Res (Hoboken)] 2018 Apr; Vol. 70 (4), pp. 516-524. - Publication Year :
- 2018
-
Abstract
- Objective: To determine the impact of stopping tumor necrosis factor inhibitor (TNFi) treatment on patient-reported outcomes (PROs) of physical and mental health status, health utility, pain, disability, and fatigue in patients with established rheumatoid arthritis (RA).<br />Methods: In the pragmatic, 12-month POET trial, 817 RA patients with ≥6 months of remission or stable low disease activity were randomized 2:1 to stopping or continuing TNFi. In case of flare, TNFi was restarted at the discretion of the rheumatologist. PROs were assessed every 3 months.<br />Results: TNFi was restarted within 12 months in 252 of 531 patients (47.5%) in the stop group. At 3 months, mean PRO scores were significantly worse in the stop group, and a larger proportion of patients experienced a minimum clinically important difference (MCID) on all PROs. Effect sizes (ES) were strongest for health utility (ES -0.24) and pain (ES -0.30). Mean scores improved again after this point, but disability scores remained significantly different at 12 months. After 12 months, the relative risk of experiencing an MCID ranged from 1.16 for mental health status to 1.58 for fatigue. Mean PRO scores for patients restarting TNFi within 6 months were no longer significantly different from those that did not restart TNFi at 12 months.<br />Conclusion: Stopping TNFi had a significant negative short-term impact on a broad range of PROs. Long-term negative consequences appeared to be limited, and outcomes in patients needing to restart TNFi within the first 6 months tended to be restored at 12 months.<br /> (© 2017, American College of Rheumatology.)
- Subjects :
- Aged
Arthritis, Rheumatoid immunology
Arthritis, Rheumatoid physiopathology
Arthritis, Rheumatoid psychology
Disability Evaluation
Drug Administration Schedule
Female
Health Status
Humans
Male
Mental Health
Middle Aged
Netherlands
Pain Measurement
Patient Reported Outcome Measures
Recurrence
Remission Induction
Time Factors
Treatment Outcome
Tumor Necrosis Factor-alpha immunology
Antirheumatic Agents administration & dosage
Arthritis, Rheumatoid drug therapy
Biological Products administration & dosage
Cost of Illness
Tumor Necrosis Factor-alpha antagonists & inhibitors
Subjects
Details
- Language :
- English
- ISSN :
- 2151-4658
- Volume :
- 70
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Arthritis care & research
- Publication Type :
- Academic Journal
- Accession number :
- 28692770
- Full Text :
- https://doi.org/10.1002/acr.23315