Why this study matters

Early treatment of RA with DMARDs is intended to slow/stop disease progression and reduce pain and disability. At the same time, it is desirable to taper or completely discontinue treatment among patients in remission while avoiding disease recurrence; however, guidelines for identifying patients who can safely undergo treatment withdrawal and predicting disease flares in such patients have not been established.

Study design

A post hoc analysis of the Assessing Very Early Rheumatoid arthritis Treatment (AVERT) phase IIIb trial was performed. During the 12-month double-blind treatment period, patients received 1 of the following 3 regimens: abatacept + methotrexate; abatacept + placebo; or methotrexate + placebo.

Treatment was discontinued in patients who achieved a Disease Activity Score in 28 joints (CRP)-defined remission after 12 months. The following putative predictors of disease flare were assessed: HAQ-DI; pain; patient-reported outcomes; and MRI synovitis, erosions, bone edema, and synovitis + bone edema inflammation scores.

Results and conclusion

Of the 172 patients in disease remission, 58% and 66% had disease flares 6 and 12 months after treatment discontinuation, respectively. The HAQ-DI and MRI inflammation scores predicted disease flare 6 and 12 months following treatment discontinuation.