Withdrawal of TNF Inibitors Fails in Most RA Patients Save

The 12 month POET study analyzed 817 rheumatoid arthritis (RA) patients who achieved remission or low disease activity (LDAS) for ≥6 months and then randomized 2:1 to stopping or continuing their TNF inhibitor. They found that stopping TNFi had significantly negative consequences in the negative short-term, with fewer long-term negative consequences to drug cessation.

At the discretion of the rheumatologist, TNFi therapy was restarted within 12 months in 47.5% of those who stopped their TNFi. Worsening was significantly evident looking at patient-reported outcomes (PROs) at 3 months.

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. 

This trial showed that stopping TNFi treatment in patients with established RA in remission or LDAS resulted in substantially more clinical flares, but that most patients who restarted TNFi treatment quickly regained remission or low disease activity.