Balay-Dustrude Erin, Fennell Jessica, Baszis Kevin, Goh Y Ingrid, Horton Daniel B, Lee Tzielan, Rotman Chloe, Sutton Anna, Twilt Marinka, Halyabar Olha
Seattle Children's Hospital and Research Center, Seattle, WA, USA.
Pediatrics, Division of Pediatric Rheumatology, University of Washington, Seattle, WA, USA.
Pediatr Rheumatol Online J. 2024 Dec 30;22(1):112. doi: 10.1186/s12969-024-01046-3.
This systematic search and review aimed to evaluate the available literature on discontinuation of adalimumab and other tumor necrosis factor inhibitors (TNFi) for patients with well-controlled chronic inflammatory arthritides.
We conducted a publication search on adalimumab discontinuation from 2000-2023 using PubMed, CINAHL, EMBASE, and Cochrane Library. Included studies evaluated adalimumab discontinuation approaches, tapering schemes, and outcomes including successful discontinuation and recapture after flare, in patients with well-controlled disease. Studies included evaluated rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, and juvenile idiopathic arthritis (JIA).
Forty-nine studies were included. Studies evaluating adalimumab alone were limited, and many reported TNFi outcomes as a single entity. Studies on rheumatoid arthritis (RA) (32, 8 RCTs) reported flare rates from 33-87%. Flares with medication tapering were slightly lower than with abrupt stop, and successful recapture was generally high (80-100%). Studies on spondyloarthropathy (12, 4 RCTs), focused on tapering, noting lower flare rates in tapering rather than abruptly stopping, and high recapture rates (~ 90%). Studies on JIA (5) were observational and demonstrated modestly lower flare rates with tapering (17-63%) versus abrupt stopping (28-82%). There was notable variability in study design, follow-up duration, specificity for TNFi results, and controlled pediatric studies.
The literature evaluating adalimumab and other TNFi discontinuation, flare rates, and recapture success within the inflammatory arthritis population demonstrated less flare when medications were tapered, over abrupt stop in the RA, spondyloarthropathy, and JIA populations. When medications were restarted after flare, recapture of well-controlled disease was generally high in RA and spondyloarthropathy, and generally favorable in JIA.
本系统检索与综述旨在评估关于已得到良好控制的慢性炎症性关节炎患者停用阿达木单抗及其他肿瘤坏死因子抑制剂（TNFi）的现有文献。
我们利用PubMed、CINAHL、EMBASE和Cochrane图书馆对2000年至2023年期间有关阿达木单抗停药的文献进行了检索。纳入的研究评估了疾病得到良好控制的患者中阿达木单抗的停药方法、逐渐减量方案以及结局，包括成功停药和病情复发后重新用药。纳入的研究涵盖类风湿性关节炎、强直性脊柱炎、银屑病关节炎和幼年特发性关节炎（JIA）。
共纳入49项研究。单独评估阿达木单抗的研究有限，许多研究将TNFi的结局作为一个整体进行报告。关于类风湿性关节炎（RA）的研究（32项，8项随机对照试验）报告的病情复发率为33%至87%。逐渐减药时的病情复发率略低于突然停药，且重新用药成功的比例普遍较高（80%至100%）。关于脊柱关节炎的研究（12项，4项随机对照试验）侧重于逐渐减药，指出逐渐减药时的病情复发率低于突然停药，且重新用药成功率较高（约90%）。关于JIA的研究（5项）为观察性研究，结果表明逐渐减药（17%至63%）时的病情复发率略低于突然停药（28%至82%）。在研究设计、随访时长、TNFi结果的特异性以及对照儿科研究方面存在显著差异。
评估炎症性关节炎人群中阿达木单抗及其他TNFi停药、病情复发率和重新用药成功率的文献表明，在RA、脊柱关节炎和JIA人群中，逐渐减药时的病情复发率低于突然停药。病情复发后重新用药时，RA和脊柱关节炎中疾病得到良好控制的重新用药成功率普遍较高，JIA中通常也较为理想。
