{"database":"biostudies-literature","file_versions":[],"scores":null,"additional":{"submitter":["Tanaka Y"],"funding":["Grant-In-Aid for Japan Agency for Medical Research and Development"],"pagination":["4273-4285"],"full_dataset_link":["https://www.ebi.ac.uk/biostudies/studies/S-EPMC9629352"],"repository":["biostudies-literature"],"omics_type":["Unknown"],"volume":["61(11)"],"pubmed_abstract":["<h4>Objective</h4>To compare the outcome of various treatment de-escalation regimens in patients with RA who achieved sustained remission.<h4>Methods</h4>At period 1, 436 RA patients who were treated with MTX and bDMARDs and had maintained DAS28(ESR) at <2.6 were divided into five groups based on shared patient/physician decision-making; continuation, dose reduction and discontinuation of MTX or bDMARDs. At end of year 1, patients who achieved DAS28(ESR) <3.2 were allowed to enrol in period 2 for treatment using the de-escalation regimens for another year. The primary and secondary endpoints were the proportion of patients with DAS28(ESR) <2.6 at year 1 and 2, respectively.<h4>Results</h4>Based on shared decision-making, 81.4% elected de-escalation of treatment and 48.4% selected de-escalation of MTX. At end of period 1, similar proportions of patients maintained DAS28(ESR) <2.6 (continuation, 85.2%; MTX dose reduction, 79.0%; MTX-discontinuation, 80.0%; bDMARD dose reduction, 73.9%), although the rate was significantly different between the continuation and bDMARD-discontinuation. At end of period 2, similar proportions of patients of the MTX groups maintained DAS28(ESR) <2.6 (continuation or de-escalation), but the rates were significantly lower in the bDMARD-discontinuation group. However, half of the latter group satisfactorily discontinued bDMARDs. Adverse events were numerically lower in MTX and bDMARD-de-escalation groups during period 1 and 2, compared with the continuation group.<h4>Conclusions</h4>After achieving sustained remission by combination treatment of MTX/bDMARDs, disease control was achieved comparably by continuation, dose reduction or discontinuation of MTX and dose reduction of bDMARDs at end of year 1. Subsequent de-escalation of MTX had no impacts on disease control but decreased adverse events in year 2."],"journal":["Rheumatology (Oxford, England)"],"pubmed_title":["Selection of treatment regimens based on shared decision-making in patients with rheumatoid arthritis on remission in the FREE-J study."],"pmcid":["PMC9629352"],"funding_grant_id":["#15ek0410016h0002"],"pubmed_authors":["Iwamoto N","Fujino Y","Kaneko Y","Yamaguchi A","Nishimoto N","Atsumi T","Kawakami A","Saito K","Hirata S","Nakano K","Nakayamada S","Fujio K","Takeuchi T","Ohmura K","Tanaka Y","Iwai H","Miyamoto T","Mimori T","Tanimura K","Murakami M","Yamanaka H","Amano K","Sumida T"],"additional_accession":[]},"is_claimable":false,"name":"Selection of treatment regimens based on shared decision-making in patients with rheumatoid arthritis on remission in the FREE-J study.","description":"<h4>Objective</h4>To compare the outcome of various treatment de-escalation regimens in patients with RA who achieved sustained remission.<h4>Methods</h4>At period 1, 436 RA patients who were treated with MTX and bDMARDs and had maintained DAS28(ESR) at <2.6 were divided into five groups based on shared patient/physician decision-making; continuation, dose reduction and discontinuation of MTX or bDMARDs. At end of year 1, patients who achieved DAS28(ESR) <3.2 were allowed to enrol in period 2 for treatment using the de-escalation regimens for another year. The primary and secondary endpoints were the proportion of patients with DAS28(ESR) <2.6 at year 1 and 2, respectively.<h4>Results</h4>Based on shared decision-making, 81.4% elected de-escalation of treatment and 48.4% selected de-escalation of MTX. At end of period 1, similar proportions of patients maintained DAS28(ESR) <2.6 (continuation, 85.2%; MTX dose reduction, 79.0%; MTX-discontinuation, 80.0%; bDMARD dose reduction, 73.9%), although the rate was significantly different between the continuation and bDMARD-discontinuation. At end of period 2, similar proportions of patients of the MTX groups maintained DAS28(ESR) <2.6 (continuation or de-escalation), but the rates were significantly lower in the bDMARD-discontinuation group. However, half of the latter group satisfactorily discontinued bDMARDs. Adverse events were numerically lower in MTX and bDMARD-de-escalation groups during period 1 and 2, compared with the continuation group.<h4>Conclusions</h4>After achieving sustained remission by combination treatment of MTX/bDMARDs, disease control was achieved comparably by continuation, dose reduction or discontinuation of MTX and dose reduction of bDMARDs at end of year 1. Subsequent de-escalation of MTX had no impacts on disease control but decreased adverse events in year 2.","dates":{"release":"2022-01-01T00:00:00Z","publication":"2022 Nov","modification":"2025-04-05T11:57:28.905Z","creation":"2025-04-05T11:57:28.905Z"},"accession":"S-EPMC9629352","cross_references":{"pubmed":["35136990"],"doi":["10.1093/rheumatology/keac075"]}}