biostudies-literatureTanaka YGrant-In-Aid for Japan Agency for Medical Research and Development4273-4285https://www.ebi.ac.uk/biostudies/studies/S-EPMC9629352biostudies-literatureUnknown61(11)<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.Rheumatology (Oxford, England)Selection of treatment regimens based on shared decision-making in patients with rheumatoid arthritis on remission in the FREE-J study.PMC9629352#15ek0410016h0002Iwamoto NFujino YKaneko YYamaguchi ANishimoto NAtsumi TKawakami ASaito KHirata SNakano KNakayamada SFujio KTakeuchi TOhmura KTanaka YIwai HMiyamoto TMimori TTanimura KMurakami MYamanaka HAmano KSumida TfalseSelection of treatment regimens based on shared decision-making in patients with rheumatoid arthritis on remission in the FREE-J study.<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 2.2022-01-01T00:00:00Z2022 Nov2025-04-05T11:57:28.905Z2025-04-05T11:57:28.905ZS-EPMC96293523513699010.1093/rheumatology/keac075