Demographics and clinical characteristics associated with sustained remission and continuation of sustained remission in patients with rheumatoid arthritis treated with adalimumab

BACKGROUND: Tumor necrosis factor inhibitor therapy for rheumatoid arthritis (RA) patients reduces disease activity, but little is known about the factors that correlate with continuation of remission. To identify demographics and clinical characteristics associated with achievement and continuation of sustained remission in patients with rheumatoid arthritis treated with adalimumab (ADA). METHODS: In this retrospective cohort study, clinical outcome was retrospectively evaluated in RA patients that received ADA at a single institution using 28-joint disease activity score with erythrocyte sedimentation rate (DAS28-ESR). Sustained remission was defined as DAS28-ESR < 2.6 for more than 6 months, and continuation of sustained remission was defined as DAS28-ESR < 2.6 that was maintained until the end of the observation period. RESULTS: Of 122 patients undergoing treatment with ADA between July 2008 and April 2014, 39 (32.0%) achieved sustained remission, and 22 of the 39 (56.4%) continued sustained remission until the end of the observation period (median, 20.5 months). Four of the 39 patients discontinued ADA because of remission, but 3 of these 4 patients restarted ADA because of RA flare. DAS28-ESR at the time of achievement of remission was lower in the subgroup of patients with continuation of sustained remission than the subgroup with RA flare. CONCLUSION: Of 122 patients, 39 (32.0%) achieved remission that was sustained for more than 6 months and 22 of the 39 patients (56.4%) continued sustained remission until the end of the observation period. Continuation of sustained remission was correlated with DAS28-ESR at the time of achievement of remission.