Ann Dermatol.  2019 Oct;31(5):495-501. 10.5021/ad.2019.31.5.495.

Is It Possible to Discontinue Tumor Necrosis Factor Antagonists after Psoriasis Remission?

Affiliations
  • 1Department of Dermatology, Pusan National University School of Medicine, Yangsan, Korea.
  • 2Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
  • 3Department of Dermatology, School of Medicine, University of California Davis, Sacramento, CA, USA.
  • 4Division of Rheumatology and Immunology, Veterans Affairs Medical Center Sacramento, Sacramento, CA, USA. sraychaudhuri@ucdavis.edu
  • 5Division of Rheumatology, Allergy and Clinical Immunology, Department of Internal Medicine, School of Medicine, University of California Davis, Sacramento, CA, USA.

Abstract

Tumor necrosis factor (TNF) antagonists are highly effective treatments for psoriasis. These agents provide the opportunity to improve disease activity and achieve clinical remission. Despite its efficacy, long-term use of biologics is associated with high financial costs and possibly life-threatening adverse events. Recently, there has been an increasing interest in discontinuing TNF antagonists in patients with psoriasis who have achieved a positive clinical response. However, there is a paucity of data and clinical guidelines concerning the cessation TNF antagonists in psoriasis treatment. Several factors, including cost, subsequent treatment efficacy, relative risks, and tolerability, should be considered before the decision is made to discontinue TNF antagonists. Well-designed clinical trials are necessary to identify factors that may trigger disease exacerbation after medication discontinuation in order to recognize the potential disadvantages of discontinuing treatment in patients who are previously successfully managed on TNF antagonists.

Keyword

Discontinuation; Psoriasis; Remission; Tumor necrosis factor antagonist; Withdrawal

MeSH Terms

Biological Products
Disease Progression
Humans
Psoriasis*
Treatment Outcome
Tumor Necrosis Factor-alpha*
Biological Products
Tumor Necrosis Factor-alpha

Reference

1. Ramirez-Fort MK, Levin AA, Au SC, Gottlieb AB. Continuous versus intermittent therapy for moderate-to-severe psoriasis. Clin Exp Rheumatol. 2013; 31:4 Suppl 78. S63–S70.
2. Mrowietz U, de Jong EM, Kragballe K, Langley R, Nast A, Puig L, et al. A consensus report on appropriate treatment optimization and transitioning in the management of moderate-to-severe plaque psoriasis. J Eur Acad Dermatol Venereol. 2014; 28:438–453.
Article
3. Kavanaugh A, Lee SJ, Curtis JR, Greenberg JD, Kremer JM, Soto L, et al. Discontinuation of tumour necrosis factor inhibitors in patients with rheumatoid arthritis in low-disease activity: persistent benefits. Data from the Corrona registry. Ann Rheum Dis. 2015; 74:1150–1155.
Article
4. Chimenti MS, Graceffa D, Perricone R. Anti-TNFα discontinuation in rheumatoid and psoriatic arthritis: is it possible after disease remission? Autoimmun Rev. 2011; 10:636–640.
Article
5. Menter A, Feldman SR, Weinstein GD, Papp K, Evans R, Guzzo C, et al. A randomized comparison of continuous vs. intermittent infliximab maintenance regimens over 1 year in the treatment of moderate-to-severe plaque psoriasis. J Am Acad Dermatol. 2007; 56:31.e1–31.e15.
Article
6. Reich K, Wozel G, Zheng H, van Hoogstraten HJ, Flint L, Barker J. Efficacy and safety of infliximab as continuous or intermittent therapy in patients with moderate-to-severe plaque psoriasis: results of a randomized, long-term extension trial (RESTORE2). Br J Dermatol. 2013; 168:1325–1334.
Article
7. Brezinski EA, Armstrong AW. Off-label biologic regimens in psoriasis: a systematic review of efficacy and safety of dose escalation, reduction, and interrupted biologic therapy. PLoS One. 2012; 7:e33486.
Article
8. Lee LY, Sanderson JD, Irving PM. Anti-infliximab antibodies in inflammatory bowel disease: prevalence, infusion reactions, immunosuppression and response, a meta-analysis. Eur J Gastroenterol Hepatol. 2012; 24:1078–1085.
9. Lecluse LL, Driessen RJ, Spuls PI, de Jong EM, Stapel SO, van Doorn MB, et al. Extent and clinical consequences of antibody formation against adalimumab in patients with plaque psoriasis. Arch Dermatol. 2010; 146:127–132.
Article
10. Kui R, Gál B, Gaál M, Kiss M, Kemény L, Gyulai R. Presence of antidrug antibodies correlates inversely with the plasma tumor necrosis factor (TNF)-α level and the efficacy of TNF-inhibitor therapy in psoriasis. J Dermatol. 2016; 43:1018–1023.
Article
11. Gordon KB, Gottlieb AB, Leonardi CL, Elewski BE, Wang A, Jahreis A, et al. Clinical response in psoriasis patients discontinued from and then reinitiated on etanercept therapy. J Dermatolog Treat. 2006; 17:9–17.
Article
12. Moore A, Gordon KB, Kang S, Gottlieb A, Freundlich B, Xia HA, et al. A randomized, open-label trial of continuous versus interrupted etanercept therapy in the treatment of psoriasis. J Am Acad Dermatol. 2007; 56:598–603.
Article
13. Gelfand JM, Kimball AB, Mostow EN, Chiou CF, Patel V, Xia HA, et al. Patient-reported outcomes and health-care resource utilization in patients with psoriasis treated with etanercept: continuous versus interrupted treatment. Value Health. 2008; 11:400–407.
Article
14. Ortonne JP, Griffiths CEM, Daudén E, Strohal R, Robertson D, Pedersen R, et al. Efficacy and safety of continuous versus paused etanercept treatment in patients with moderate-to-severe psoriasis over 54 weeks: the CRYSTEL study. Expert Rev Dermatol. 2008; 3:657–665.
Article
15. Griffiths CE, Luger TA, Brault Y, Germain JM, Mallbris L. Retreatment in patients with psoriasis achieving response with etanercept after relapse due to treatment interruption: results from the CRYSTEL study. J Eur Acad Dermatol Venereol. 2015; 29:468–473.
Article
16. Papp K, Crowley J, Ortonne JP, Leu J, Okun M, Gupta SR, et al. Adalimumab for moderate to severe chronic plaque psoriasis: efficacy and safety of retreatment and disease recurrence following withdrawal from therapy. Br J Dermatol. 2011; 164:434–441.
Article
17. Papp K, Menter A, Poulin Y, Gu Y, Sasso EH. Long-term outcomes of interruption and retreatment vs. continuous therapy with adalimumab for psoriasis: subanalysis of REVEAL and the open-label extension study. J Eur Acad Dermatol Venereol. 2013; 27:634–642.
Article
18. Gordon KB, Gottlieb AB, Langely RG, van de Kerkhof P, Belasco KT, Sundaram M, et al. Adalimumab retreatment successfully restores clinical response and health-related quality of life in patients with moderate to severe psoriasis who undergo therapy interruption. J Eur Acad Dermatol Venereol. 2015; 29:767–776.
Article
19. Tanaka Y. Stopping tumour necrosis factor-targeted biological DMARDs in rheumatoid arthritis. Rheumatology (Oxford). 2016; 55:suppl 2. ii15–ii22.
Article
20. Smolen JS, Landewé R, Bijlsma J, Burmester G, Chatzidionysiou K, Dougados M, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update. Ann Rheum Dis. 2017; 76:960–977.
21. Edwards CJ, Fautrel B, Schulze-Koops H, Huizinga TWJ, Kruger K. Dosing down with biologic therapies: a systematic review and clinicians’ perspective. Rheumatology (Oxford). 2017; 56:1847–1856.
Article
22. Felson DT, Smolen JS, Wells G, Zhang B, van Tuyl LH, Funovits J, et al. American College of Rheumatology. European League Against Rheumatism. American College of Rheumatology/European League Against Rheumatism provisional definition of remission in rheumatoid arthritis for clinical trials. Arthritis Rheum. 2011; 63:573–586.
23. Singh JA, Saag KG, Bridges SL Jr, Akl EA, Bannuru RR, Sullivan MC, et al. 2015 American College of Rheumatology Guideline for the treatment of rheumatoid arthritis. Arthritis Rheumatol. 2016; 68:1–26.
Article
24. Atzeni F, Benucci M, Talotta R, Masala IF, Sarzi-Puttini P, Govoni M. What are the dangers of biological therapy discontinuation or dose reduction strategies when treating rheumatoid arthritis? Expert Rev Clin Pharmacol. 2016; 9:1403–1411.
Article
25. Schett G, Emery P, Tanaka Y, Burmester G, Pisetsky DS, Naredo E, et al. Tapering biologic and conventional DMARD therapy in rheumatoid arthritis: current evidence and future directions. Ann Rheum Dis. 2016; 75:1428–1437.
Article
26. Lubrano E, Soriano E, FitzGerald O. Can traditional disease-modifying anti-rheumatic drugs be withdrawn or tapered in psoriatic arthritis? Clin Exp Rheumatol. 2013; 31:4 Suppl 78. S54–S58.
27. Cantini F, Niccoli L, Nannini C, Cassarà E, Pasquetti P, Olivieri I, et al. Frequency and duration of clinical remission in patients with peripheral psoriatic arthritis requiring second-line drugs. Rheumatology (Oxford). 2008; 47:872–876.
Article
28. Coates LC, Helliwell PS. Validation of minimal disease activity criteria for psoriatic arthritis using interventional trial data. Arthritis Care Res (Hoboken). 2010; 62:965–969.
Article
29. Mease P. Is reduction or discontinuation of therapy an acceptable possibility in psoriatic arthritis? Clin Exp Rheumatol. 2013; 31:4 Suppl 78. S59–S62.
30. Kane D, Stafford L, Bresnihan B, FitzGerald O. A prospective, clinical and radiological study of early psoriatic arthritis: an early synovitis clinic experience. Rheumatology (Oxford). 2003; 42:1460–1468.
Article
31. Saber TP, Ng CT, Renard G, Lynch BM, Pontifex E, Walsh CA, et al. Remission in psoriatic arthritis: is it possible and how can it be predicted? Arthritis Res Ther. 2010; 12:R94.
Article
32. Araujo EG, Finzel S, Englbrecht M, Schreiber DA, Faustini F, Hueber A, et al. High incidence of disease recurrence after discontinuation of disease-modifying antirheumatic drug treatment in patients with psoriatic arthritis in remission. Ann Rheum Dis. 2015; 74:655–660.
Article
33. Moverley A, Coates L, Marzo-Ortega H, Waxman R, Torgerson D, Cocks K, et al. A feasibility study for a randomised controlled trial of treatment withdrawal in psoriatic arthritis (REmoval of treatment for patients in REmission in psoriatic ArThritis (RETREAT (F)). Clin Rheumatol. 2015; 34:1407–1412.
Article
34. Cantini F, Niccoli L, Cassarà E, Kaloudi O, Nannini C. Sustained maintenance of clinical remission after adalimumab dose reduction in patients with early psoriatic arthritis: a long-term follow-up study. Biologics. 2012; 6:201–206.
Article
35. Huynh DH, Etzel CJ, Cox V, Mease PJ, Kavanaugh A. Persistence of low disease activity after tumor necrosis factor inhibitor withdrawal in patients with psoriatic arthritis. In : Proceedings of 2014 ACR/ARHP Annual Meeting; 2014 Nov 14–19; Boston, USA. Abstract number: 1594.
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