Inhibitors of tumor necrosis factor alpha (TNF-α) are current mainstay of therapies for rheumatoid arthritis (RA). The decision when to withdraw TNF-α inhibitors after achieving remission and the incidence of relapse rates with elective discontinuation are both important questions that demand intense survey in these patients. In this meta-analysis we aimed to estimate the magnitude of relapse rate after elective TNF-α inhibitor discontinuation in RA patients with remission. Systematic searches of PubMed/MEDLINE, Cochrane Library databases, grey literature (unpublished and ongoing trials) from the WHO International Clinical Trials Registry Platform and the US National Institutes of Health were performed for studies reporting the outcomes of elective discontinuation of TNF-α inhibitor in RA patients after remission. Random-effects models for meta-analyses were conducted on extracted data. Out of 390 references screened, 16 RCTs were included. Meta-analysis of 1264 patient data revealed a relapse rate of 0.47 (95% CI 0.41–0.54). Sensitivity analysis showed that none of the studies had higher influence on the results. Almost half of all the RA patients in remission relapse after elective TNF-α inhibitor discontinuation. This information might be useful when considering this management option with individual patients.

中文翻译：

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类风湿性关节炎选择性停止抗 TNF 治疗后的复发率：荟萃分析和文献回顾

肿瘤坏死因子 α (TNF-α) 抑制剂是目前治疗类风湿性关节炎 (RA) 的主要药物。达到缓解后何时停用 TNF-α 抑制剂的决定以及选择性停药的复发率都是需要对这些患者进行深入调查的重要问题。在这项荟萃分析中，我们旨在估计缓解的 RA 患者在选择性 TNF-α 抑制剂停药后复发率的大小。对来自 WHO 国际临床试验注册平台和美国国立卫生研究院的 PubMed/MEDLINE、Cochrane 图书馆数据库、灰色文献（未发表和正在进行的试验）进行了系统检索，用于报告选择性停用 TNF-α 抑制剂的结果的研究。 RA患者缓解后。对提取的数据进行了荟萃分析的随机效应模型。在筛选的 390 篇参考文献中，纳入了 16 篇 RCT。对 1264 例患者数据的荟萃分析显示复发率为 0.47（95% CI 0.41–0.54）。敏感性分析表明，没有一项研究对结果有更高的影响。几乎一半的 RA 患者在选择性 TNF-α 抑制剂停药后缓解复发。在考虑对个别患者进行此管理选项时，此信息可能很有用。几乎一半的 RA 患者在选择性 TNF-α 抑制剂停药后缓解复发。在考虑对个别患者进行此管理选项时，此信息可能很有用。几乎一半的 RA 患者在选择性 TNF-α 抑制剂停药后缓解复发。在考虑对个别患者进行此管理选项时，此信息可能很有用。