The aim of this study was to identify predictors of prolonged disease control after discontinuation of tumor necrosis factor inhibitor (TNFi) treatment in patients with rheumatoid arthritis (RA). Post-hoc analysis of 439 RA patients (67.3% rheumatoid factor positive) with longstanding RA in remission or with stable low disease activity, randomized to stopping TNFi treatment in the multicenter POET trial. Prolonged acceptable disease control was defined as not restarting TNFi treatment within 12 months after stopping. Baseline demographic and disease-related variables were included in univariate and multivariate logistic regression analysis for identifying predictors of relapse. One year after baseline, 220 patients (50.1%) had not restarted TNFi treatment. Use of an anti-TNF monoclonal antibody (versus a receptor antagonist, OR = 2.41; 95% CI: 1.58–3.67), ≤10 yrs. disease duration (OR = 2.15; 95% CI: 1.42–3.26) and low or moderate multi-biomarker disease activity (MBDA) scores (OR = 2.00; 95% CI: 1.10–3.64) at baseline were independently predictive of successful TNFi discontinuation (area under the receiver operating characteristic curve = 0.66; 95% CI: 0.61–0.71). Results were similar when using no physician-reported flare as the criterion. TNFi-free survival was significantly different for patient groups based on the number of predictors present, ranging from 21.4% of patients with no predictor present to 66.7% of patients with all three predictors present. Patients using an anti-TNF monoclonal antibody, with shorter disease duration and low or moderate baseline MBDA score are most likely to achieve prolonged disease control after TNFi discontinuation. Netherlands Trial Register NTR3112 , 21 October 2011.

中文翻译：

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类风湿关节炎患者停止肿瘤坏死因子抑制剂治疗后无生物疾病控制的预测因素

本研究的目的是确定类风湿性关节炎 (RA) 患者在停止肿瘤坏死因子抑制剂 (TNFi) 治疗后疾病控制延长的预测因素。在多中心 POET 试验中，对 439 名 RA 患者（67.3% 类风湿因子阳性）长期缓解或疾病活动度稳定低的 RA 患者进行事后分析，随机分配至停止 TNFi 治疗。长期可接受的疾病控制定义为停止后 12 个月内未重新开始 TNFi 治疗。基线人口统计学和疾病相关变量包括在单变量和多变量逻辑回归分析中，以确定复发的预测因子。基线后一年，220 名患者（50.1%）没有重新开始 TNFi 治疗。使用抗 TNF 单克隆抗体（相对于受体拮抗剂，OR = 2.41；95% CI：1。58–3.67)，≤10 岁。基线时的疾病持续时间（OR = 2.15；95% CI：1.42-3.26）和低或中度多生物标志物疾病活动（MBDA）评分（OR = 2.00；95% CI：1.10-3.64）独立预测成功停用 TNFi （受试者工作特征曲线下面积 = 0.66；95% CI：0.61–0.71）。当使用没有医生报告的耀斑作为标准时，结果是相似的。根据存在的预测因子数量，患者组的无 TNFi 存活率显着不同，从没有预测因子的 21.4% 的患者到所有三个预测因子都存在的患者的 66.7%。使用抗 TNF 单克隆抗体、病程较短、基线 MBDA 评分较低或中等的患者最有可能在 TNFi 停药后实现长期的疾病控制。