{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T02:12:38Z","timestamp":1792807958238,"version":"4.5.0"},"reference-count":34,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2021,3,24]],"date-time":"2021-03-24T00:00:00Z","timestamp":1616544000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100002429","name":"Amgen","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100002429","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["acrjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthritis &amp; Rheumatology"],"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Patients with rheumatoid arthritis (RA) in whom remission is achieved following combination therapy with methotrexate plus etanercept face an ongoing medication burden. This study was undertaken to investigate whether sustained remission achieved on combination therapy can be maintained with either methotrexate or etanercept monotherapy, as assessed following discontinuation of one or the other medication from the combination.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Of the 371 adult patients with RA who received combination therapy with methotrexate plus etanercept, remission (defined as a Simplified Disease Activity Index [SDAI] score of \u22643.3) was sustained in 253 patients through a 24\u2010week open\u2010label period. These 253 patients then entered a 48\u2010week, double\u2010blind period and were randomized to receive either 1) methotrexate monotherapy (n = 101), 2) etanercept monotherapy (n = 101), or 3) methotrexate plus etanercept combination therapy (n = 51). Patients who subsequently experienced disease\u2010worsening received rescue therapy with the combination regimen at the same dosages as used in the initial run\u2010in period. The primary end point was the proportion of patients in whom SDAI\u2010defined remission was maintained without disease\u2010worsening at week 48 in the etanercept monotherapy group as compared to the methotrexate monotherapy group. Secondary end points included time to disease\u2010worsening, and the proportion of patients in whom SDAI\u2010defined remission was recaptured after initiation of rescue therapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Baseline demographic and clinical characteristics of the RA patients were similar across the treatment groups. At week 48, SDAI\u2010defined remission was maintained in significantly more patients in the etanercept monotherapy group than in the methotrexate monotherapy group (49.5% versus 28.7%; <jats:italic>P<\/jats:italic> = 0.004). Moreover, as a secondary end point, sustained SDAI\u2010defined remission was achieved in significantly more patients who received combination therapy than in those who received methotrexate monotherapy (52.9% versus 28.7%; <jats:italic>P<\/jats:italic> = 0.006). Time to disease\u2010worsening was shorter in those who received methotrexate monotherapy than in those who received etanercept monotherapy or those who received combination therapy (each <jats:italic>P<\/jats:italic> &lt; 0.001 versus methotrexate monotherapy). Among the patients who received rescue therapy, SDAI\u2010defined remission was recaptured in 70\u201380% in each treatment group. No new safety signals were reported.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The efficacy of etanercept monotherapy was superior to that of methotrexate monotherapy and similar to that of combination therapy in maintaining remission in patients with RA. SDAI\u2010defined remission was recaptured in most of the patients who were given rescue therapy. These data could inform decision\u2010making when withdrawal of therapy is being considered to reduce treatment burden in patients with well\u2010controlled RA.<\/jats:p><\/jats:sec>","DOI":"10.1002\/art.41589","type":"journal-article","created":{"date-parts":[[2020,11,18]],"date-time":"2020-11-18T10:48:25Z","timestamp":1605696505000},"page":"759-768","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":53,"title":["Etanercept or Methotrexate Withdrawal in Rheumatoid Arthritis Patients in Sustained Remission"],"prefix":"10.1002","volume":"73","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8907-8976","authenticated-orcid":false,"given":"Jeffrey R.","family":"Curtis","sequence":"first","affiliation":[{"name":"University of Alabama at Birmingham"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7429-8482","authenticated-orcid":false,"given":"Paul","family":"Emery","sequence":"additional","affiliation":[{"name":"Leeds Institute of Rheumatic and Musculoskeletal Medicine University of Leeds NIHR Leeds Biomedical Research Centre Leeds Teaching Hospitals NHS Trust  Leeds UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8520-2549","authenticated-orcid":false,"given":"Elaine","family":"Karis","sequence":"additional","affiliation":[{"name":"Amgen Inc.  Thousand Oaks California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9077-2201","authenticated-orcid":false,"given":"Boulos","family":"Haraoui","sequence":"additional","affiliation":[{"name":"Centre Hospitalier de l\u2019Universit\u00e9 de Montr\u00e9al  Montreal Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1219-3845","authenticated-orcid":false,"given":"Vivian","family":"Bykerk","sequence":"additional","affiliation":[{"name":"Hospital for Special Surgery  New York New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priscilla K.","family":"Yen","sequence":"additional","affiliation":[{"name":"Amgen Inc.  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