Cytokine Signalling Forum

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Discontinuation of Tofacitinib after achieving Low Disease Activity in Patients with Rheumatoid Arthritis: a Multicentere, Observational Study

Kubo S, Yamaoka K, Amano K, Nagano S, Tohma S, Suematsu E, Nagasawa H, Iwata K and Tanaka Y. - Rheumatology. Doi 10.1093/rheumatology/kex068

This study showed that in patients who achieved low disease activity (LDA), it is possible to discontinue tofacitinib without flare in approximately one-third of patients.

Patients from the tofacitinib Phase 3 programme and long-term extension study were enroled. Discontinuation was based on physician-patient decision making with informed consent. The primary endpoint was the proportion of patients who remained tofacitinib free at post-treatment Week 52.

Of 64 patients treated with tofacitinib who achieved LDA at the end of the clinical trial period, 54 patients discontinued and 10 continued treatment. Disease activity at post-treatment Week 52 was higher in in the discontinuation versus continuation group.

Of the 54 patients who discontinued tofacitinib treatment, 20 (37%) remained tofacitinib-free at
post-treatment Week 52. RF titre at baseline correlated with remaining tofacitinib free at Week 52, with mean titre significantly lower in those who remained tofacitinib free versus those who did not (40 U/ml vs 113 U/ml, respectively). In patients who could not achieve tofacitinib-free status, disease activity was improved by re-starting tofacitinib or biologic therapy.

This study demonstrates that tofacitinib can be discontinued in some patients with RA after achieving LDA. This is important for clinical practice since treatment with bDMARDs and tsDMARDs may pose financial problems, compounded by long-term use.