Intensive treatment and treatment holiday of TNF-inhibitors in rheumatoid arthritis

Purpose of review Biologics targeting tumor necrosis factor (TNF) has revolutionized the treatment of rheumatoid arthritis (RA) and clinical remission becomes a realistic treatment goal. After achieving remission, discontinuation of TNF inhibitors may become an important issue from viewing points of safety and economy. However, there is not well established firm evidence regarding biologic-free remission. We here document whether 'treatment holiday' of TNF inhibitors is possible in RA patients, after maintaining low disease activity by intensive treatment with TNF inhibitors. Recent findings From European studies such as BeSt and OPTIMA in patients with early RA and Japanese studies such as RRR and HONOR in patients with established RA, after reduction of disease activity to clinical remission or low disease activity in patients with RA by infliximab or adalimumab in combination with methotrexate, some patients could successfully remain in clinical remission without TNF inhibitors for 6 months or 1 year and without radiologic and functional progression of articular destruction. Summary After maintaining low disease activity by intensive treatment with TNF inhibitors, discontinuation of TNF inhibitors without disease flare, joint damage progression and functional impairment, treatment holiday, is possible in some RA patients.