Stopping adalimumab associated with high rates of low disease activity in RA

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Takeaway

  • 3 y after discontinuing adalimumab (ADA), 4 in 5 patients with rheumatoid arthritis (RA) in this observational study remained in low disease activity (LDA), with fewer adverse events than those who continued ADA.
  • Continuing ADA led to higher rates of LDA as well as of adverse events.

Why this matters

  • Although effective in RA, biological agents like ADA are associated with higher infection risk.
  • The long-term safety and efficacy of continuing vs discontinuing ADA have been unclear.

Key results

  • At wk 208, 95.1% of ADA continuation patients and 79.7% of ADA discontinuation patients had LDA.
  • The ADA discontinuation group had significantly fewer adverse events vs continuation group (9.7% vs 32.9%; P<.001).

Study design

  • HOPEFUL-3 was 2-y observational study of 135 participants of HOPEFUL-2 and -1.
  • In HOPEFUL-1, participants were randomly assigned to 26 wk of ADA+methotrexate (MTX) (intensive therapy) or MTX alone, then ADA+MTX for 26 wk.
  • In HOPEFUL-2, participants took 52 wk of ADA+MTX (ADA continuation) or MTX alone (ADA discontinuation).
  • Primary endpoints: 28-joint Disease Activity Score using C-reactive protein score and achievement of LDA (DAS28-CRP, <3.2) at wk 208.
  • Funding: AbbVie GK; Eisai Co., Ltd.

Limitations

  • Observational study.
  • HOPEFUL-2 not randomized.
  • Steroid use not taken into account.