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Outcomes Switching to Monotherapy: SEAM-RA Trial

Eric Dein, MD

Combination therapy with biologic and conventional DMARDs can be highly effective at inducing remission in patients with RA. Once controlled, patients are often interested in stopping combination drug therapy due to concerns related to medication burdens, side effect profiles, or safety. 

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Etanercept monotherapy significantly more effective than Methotrexate monotherapy in maintaining remission in RA patients on combination therapy. Data from the SEAM-RA study @RheumNow #ACR20 Abstr#0939 #ACRbest

Dr. Antoni Chan synovialjoints ( View Tweet)

Rheumatoid arthritis and lung disease in the spotlight at #ACR20 by @jeffsparks https://t.co/0Dth0k6uve https://t.co/pGfGtq8Sz7

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Dr. John Cush RheumNow ( View Tweet)

After the SEAM-RA study, in patients taking MTX and ETN in sustained remission would you? #ACR20 @rheumnow

Richard Conway RichardPAConway ( View Tweet)

We have great options all around! Both are efficacious in biologic (TNFi) failures for RA patients. Comparative Clinical Efficacy of Sarilumab versus Upadacitinib over 12 Weeks: Matching-Adjusted Indirect Comparison Analysis Abst#0827 #ACR20 @RheumNow https://t.co/1SsL9qLJD3

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k dao KDAO2011 ( View Tweet)

When you counsel patients w/RA, do you warn them that during times of dz flare, their ability to drive may be affected? ...maybe you should based on Abstr#0198 #ACR20 @rheumnow

k dao KDAO2011 ( View Tweet)

Nice insights into RA-ILD from @jeffsparks: - assoc (in Medicare): male, smoker, asthma/COPD, b/tsDMARDs, steroids - mortality risk? Yes, esp resp (sdHR 4.4), cancer - ACPA/lung inflamm related to RA-ILD? Yes, esp anti-filaggrin (aOR 3.08/log unit) #ACR20 ABST0489/0490 @RheumNow https://t.co/DGkNNPOcbd
David Liew drdavidliew ( View Tweet)
Be sure to check this session with @CCalabreseDO and Dr. Gordon Lam on the role of IL6 in inflammation, RA, and CRS at 2 pm EST today! #ACR20 @RheumNow https://t.co/c4oX1tNeId
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
Is it time to change RA EULAR guidelines to reflect what we do? SEAM RCT showed withdrawal of MTX better than D/C etanercept in controlled RA. ETN alone =ETN+MTX. I vote to d/c the Rx that failed or by pt preference! Abstr#939 @RheumNow #ACR20 https://t.co/l9TNM3Gt0e
Janet Pope Janetbirdope ( View Tweet)
RheumNow’s expanded coverage of the #ACR20 Annual meeting is sponsored in part by @bmsnews, @HorizonNews, @SanofiGenzyme, @Novartis. All content chosen by RheumNow and its Faculty.

Dr. John Cush RheumNow ( View Tweet)

Poll results are in... most chose upadacitinib followed by tofacitinib as their Jak-i of choice if insurance approval was not a factor in those that failed a bDMARD and remain on a cDMARD with high dz activity! @RheumNow @LCalabreseDO @ElaineHusniMD #ACR20 https://t.co/rl1nTqxzKg

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Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)

Dr Curtis presents SEAM-RA RCT of withdrawal of ETN or MTX in patients on combo therapy in sustained remission. 49.5% of ETN mono retained remission compared to 28.7% of MTX mono, and 52.9% who continued combo therapy. @rheumnow #ACR20 Abstr#939 #ACRbest https://t.co/wpAtBHJYUF
Richard Conway RichardPAConway ( View Tweet)
Important things to take note of re: HBV reactivation (risk stratification and RR) when we consider therapies for our RA pts. 👇 @RheumNow #ACR20 #MedTwitter https://t.co/ZJfnZHpmfw
sheila RHEUMarampa ( View Tweet)

Another biosimilar Adalimumab. SB5 switch in RA, PsA & SpA N=354 No diff in effectiveness Some minor flares. Some changed dose unsure why. #ACR2020 @RheumNow @CRASCRRheum abstr#805 https://t.co/2Zb4H2jBXQ

Janet Pope Janetbirdope ( View Tweet)
Liver damage is NOT an extra-articular manifestation of RA BUT the ff'g factors are associated with liver disease in RA & can complicate management👇@RheumNow #ACR20 https://t.co/RqL69iVJpC
sheila RHEUMarampa ( View Tweet)
What is refractory RA? Inability to reach #T2T goals of remission or at least LDA despite various changes of tx. "We should aim at best care for the tx of refractory RA"-Prof.Josef Smolen @RheumNow #ACR20 https://t.co/7Wxjd5t3Oi
sheila RHEUMarampa ( View Tweet)
Interesting study suggesting decreasing RF titers can be a biomarker to predict radiographic remission. Will you change your practice to do serial RF measurements? @rheumnow #ACR20 #ACRbest https://t.co/MvxBv0Kdek

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k dao KDAO2011 ( View Tweet)

Nintedanib for RA-ILD? In the INBUILD Trial, pts on Nintedanib did better than PBO, efficacy similar among autoimmune ILDs including RA. @RheumNow #ACR20 @joanbathon https://t.co/I4AJlemIhD
sheila RHEUMarampa ( View Tweet)
OBRI Canadian registry showed real world retention data for Tofa and TNFi are both similar, but RA pts on TNFi w/o MTX d/c drug more compared to those who stay on MTX (does not matter with Tofa if they are on MTX) Abstr#808 #ACR20 @rheumnow https://t.co/TDmV0EJTp8

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k dao KDAO2011 ( View Tweet)

SEAM-RA: SDAI remission greater in pts on ETN alone vs. MTX alone; ⬆ pts in remission w/ combined tx vs. MTX alone. These may guide tx decisions re withdrawal in well-controlled RA @Rheumnow #ACR20 https://t.co/33GhuMuL3I

sheila RHEUMarampa ( View Tweet)
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