The results? “The ones who did well in period 1 also continued to do very well in period 2,” including those who stopped their biologic, says lead study author Josef S. Smolen, MD, from the division of rheumatology at the Medical University of Vienna.

“Patients achieving the stable low disease activity target on adalimumab plus methotrexate who withdrew adalimumab mostly maintained their good responses,” the authors write. But they add, “an estimated one in 11 patients might have benefited from further treatment adjustment,” for instance, by adding another DMARD or a corticosteroid or resuming adalimumab.

The study didn’t follow the patients beyond period 2. “Follow-up beyond 78 weeks will be needed to fully appraise the efficacy of biological withdrawal,” the authors write. It also didn’t look at what would happen if people who stopped adalimumab and experienced a flare started the drug again.

“I think the study was well done,” says Eric L. Matteson, MD, chair of the division of rheumatology at Mayo Clinic in Rochester, Minn. “There are two messages: Starting DMARD therapy in patients with new-onset rheumatoid arthritis leads to markedly improved outcomes and overall good control, and in a significant number of patients who are started on combinations of methotrexate and adalimumab, the adalimumab can be discontinued without loss of disease control or damage to joints.”

How can adalimumab keep working after the patient stops taking it? “The pharmacologic effect of adalimumab is generally gone after two weeks,” says Dr. Matteson. “However, it may have much longer effects on immune regulation which are due to complex mechanisms of immune response.” In other words, the drug may change how the immune system works by breaking the cycle of the inflammatory response.

The study looked only at patients with early rheumatoid arthritis. A separate trial (from different researchers) suggested that people with more established RA who begin a TNF inhibitor are likely to experience a flare after stopping it.

“This outcome has great implications for care of patients and economic aspects of treatment of rheumatoid arthritis with expensive biological agents, and could lead to changes in existing treatment frameworks,” the authors write.

Dr. Matteson’s message to people taking adalimumab in combination with another drug is this: “I would advise them that there is a reasonable possibility that they may be able to go off of one of the drugs in the combination over time, perhaps after one to two years, and continue to do well.”