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For patients with rheumatoid arthritis (RA), patient-reported outcomes (PROs) generally worsen shortly after tumor necrosis factor inhibitor (TNFi) discontinuation, according to a study published in the Journal of Rheumatology.

Michael M. Ward, M.D., M.P.H., from the National Institutes of Health in Bethesda, Maryland, and colleagues compared PROs over 48 weeks in a randomized, double-blind trial involving patients with RA in sustained remission/low disease activity treated with TNFi. Participants were randomly assigned to placebo (discontinuation of TNFi; 69 patients) or continuation of TNFi (33 patients).

The researchers found that group mean scores on the patient global assessment, pain score, and Health Assessment Questionnaire-Disability Index were significantly higher in the placebo than the TNFi group during the trial. Small or moderate effect sizes were seen for all PROs.

All measures were significantly higher in the placebo group at week 12 compared with week 0, but not at later times, corresponding with the timing of most relapses. The domains most affected were Short Form-36 bodily pain and social function. By trial end, after resuming TNFi treatment, PROs returned to baseline values.

"Patients who discontinued TNFi were more likely than those who continued TNFi to have worsening of several aspects of self-rated health. However, worsening tended to occur early after TNFi discontinuation, was generally moderate in severity, and was temporary, with most measures returning to baseline by trial end," the authors write.

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