Factors associated with the achievement of biological disease-modifying antirheumatic drug-free remission in rheumatoid arthritis: the ANSWER cohort study

Table 2 Hazard ratios for bDMARD-free remission failure (univariate analysis)

Factor	HR (95% CI)	p value
Type of bDMARD
TNFi(mAb)/TNFi(R/P)	0.56 (0.35–0.87)	0.01
TNFi(mAb)/CTLA4-Ig	0.87 (0.48–1.57)	0.65
TNFi(mAb)/IL-6Ri	0.42 (0.28–0.63)	< 0.01
CTLA4-Ig/TNFi(R/P)	0.64 (0.33–1.24)	0.19
CTLA4-Ig/IL-6Ri	0.48 (0.25–0.91)	0.03
TNFi(R/P)/IL-6Ri	0.75 (0.46–1.25)	0.27
Age (years)	1.00 (0.99–1.01)	0.88
Sex, female/male	0.79 (0.53–1.20)	0.26
Disease duration, < 2 years/≥ 2 years	0.63 (0.45–0.88)	0.01
Disease duration (years)	1.03 (1.01–1.05)	< 0.01
Smoking status, current/previous or never	0.62 (0.27–1.21)	0.17
Anti-CCP antibody, positive/negative	1.47 (0.84–2.81)	0.19
Rheumatoid factor, positive/negative	1.39 (0.91–2.21)	0.13
bDMARD-naïve, naïve/switch	0.56 (0.40–0.79)	< 0.01
Reason for discontinuation, remission/other reason	0.36 (0.22–0.58)	< 0.01
Boolean remission at the time of discontinuation, achieved/not achieved	0.42 (0.29–0.60)	< 0.01
Remission maintenance period before discontinuation, > 6 months/≥ 6 months	0.33 (0.22–0.50)	< 0.01
Methotrexate usage at the time of discontinuation, yes/no	0.65 (0.45–0.96)	0.03
Methotrexate dosage at the time of discontinuation (mg/week)	0.95 (0.92–0.99)	0.02
Glucocorticoid usage at the time of discontinuation, yes/no	2.03 (1.46–2.82)	< 0.01
Glucocorticoid dosage at the time of discontinuation (mg/day)	1.01 (0.98–1.02)	0.56

Patients classified based on types of bDMARDs, disease duration, anti-CCP or RF status, smoking status, bDMARD status (naïve or switched), reasons for bDMARD discontinuation, DAS28-CRP remission maintenance period before bDMARD discontinuation, achievement of Boolean remission at time of bDMARD discontinuation, and concomitant use of MTX or glucocorticoids at time of bDMARD discontinuation. HRs with 95% CIs obtained using Cox’s proportional hazard model
bDMARD biological disease-modifying antirheumatic drug, HR hazard ratio, CI confidence interval, TNFi(mAb) monoclonal antibodies against TNF (infliximab, adalimumab, and golimumab), TNFi(R/P) soluble TNF receptor or Fab fragments against TNF fused with polyethylene glycol (etanercept and certolizumab), CTLA4-Ig abatacept, IL-6Ri interleukin-6 receptor inhibitor (tocilizumab), DAS28-CRP Disease Activity Score 28—C-reactive protein, CCP cyclic citrullinated peptide, TNF tumor necrosis factor, RF rheumatoid factor, MTX methotrexate

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