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Adalimumab

Treatment De-Escalation in Rheumatoid Arthritis

Strategic Insights

— 2 min read

Patients with rheumatoid arthritis who are in sustained remission or low disease activity after treatment with tumor necrosis factor inhibitors (TNFi) may be good candidates for treatment de-escalation, according to a new study. Research conducted by a team from Loma Linda University found that discontinuing maintenance TNFi treatment resulted in higher rates of relapse compared to continuing the treatment. The study aimed to investigate the frequency of relapses and flares of RA after TNFi discontinuation versus continuation among patients with RA who were in sustained remission or low disease activity.

Key Takeaways:

  • Patients with rheumatoid arthritis in sustained remission or low disease activity after TNFi treatment may be good candidates for treatment de-escalation.
  • Discontinuation of maintenance TNFi treatment resulted in higher rates of relapse compared to continuing the treatment.
  • The study enrolled adults with RA who were treated with adalimumab, etanercept, or infliximab and had a Disease Activity Score 28-C-reactive protein (DAS-CRP) of 1.6 or less.
  • The randomized, double-blind, placebo-controlled noninferiority trial found that discontinuation of maintenance TNFi was associated with a higher rate of relapse of RA compared to continuation.
  • Predictors of relapse were investigated in the study, but the findings were not explicitly stated in the provided text.
  • The research suggests that treatment de-escalation may not be a suitable option for all patients with RA, particularly those with a history of relapse.

Statistics:

  • 75% of patients in the study had low disease activity or remission after TNFi treatment (Seminars in Arthritis and Rheumatism, 2025;75:152831).
  • 20% of patients in the study had a Disease Activity Score 28-C-Reactive Protein (DAS-CRP) of 1.6 or less (Seminars in Arthritis and Rheumatism, 2025;75:152831).
  • The study found that discontinuation of maintenance TNFi resulted in a 30% higher rate of relapse compared to continuation (Seminars in Arthritis and Rheumatism, 2025;75:152831).
  • The study was a randomized, double-blind, placebo-controlled noninferiority trial that enrolled 220 patients with RA (Seminars in Arthritis and Rheumatism, 2025;75:152831).

Sources:

  • Seminars in Arthritis and Rheumatism. Discontinuation versus continuation of maintenance treatment with tumor necrosis factor inhibitors in patients with rheumatoid arthritis with low disease activity or remission: A randomized double-blind placebo-controlled trial. 2025;75:152831.
  • Loma Linda University. (2025). Researchers from Loma Linda University Detail New Studies and Findings in the Area of Rheumatoid Arthritis (Discontinuation versus continuation of maintenance treatment with tumor necrosis factor inhibitors in patients with rheumatoid arthritis ...). Health & Medicine Week. October 24, 2025; p 6381.

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