"The results of a study presented today at the European League Against Rheumatism Annual Congress EULAR  showed that in rheumatoid arthritis RA patients a good clinical response to maintenance treatment with a tumour necrosis factor inhibitor TNFi was maintained even when the dose was reduced by onethird.  Reducing the TNFi dose by twothirds resulted in more flares exacerbations of symptoms and signs but these subsided when the higher dose of TNFi was restarted and did not adversely affect subsequent progression of any disability. In some cases however patients maintained a clinical response after stopping the TNFi altogether.  The optimal management of RA involves achieving the lowest possible disease activity  ideally remission and then maintaining this level of control said lead author Dr. James Galloway Department of Rheumatology Kings College Hospital NHS Foundation Trust UK. Findings from our study have shown that adopting a TNFi dose reduction strategy can still meet this objective with no compromise on symptom control for the patient and offering a more costeffective option by substantially reducing the high drug costs associated with TNFi maintenance therapy.  RA is a chronic inflammatory disease characterised by joint inflammation and damage functional disability and significantly increased mortality. Early intervention using a conventional synthetic diseasemodifying antirheumatic drug DMARD such as methotrexate is critical in preventing structural joint damage and progressive loss of function. For those patients who either fail to respond or who develop an inadequate response to these drugs over time a biologic DMARD is an effective addon treatment option. The first choice of biologic therapy is usually a TNFi and currently identical dosing regimens of TNFi are used both to induce and then maintain a clinical response.  Over the first six months of the study flares exacerbations of symptoms and signs occurred in  of patients who stayed on the same TNFi dose compared to a similar figure of  in those patients for whom the dose was reduced by onethird. A twothirds dose reduction increased the odds of a flare occurring by four times compared with a onethird dose reduction with flares occurring in  of patients. Postdose reduction flares resolved when the original dose of TNFi was restarted. There were no significant differences in selfreported measures of disability Health Assessment Questionnaire score with either dose reduction strategy at six months.  The OPTTIRA study is a month multicentre randomised controlled trial designed to evaluate if reducing TNFi doses of either etanercept or adalimumab caused a loss of response in RA patients who were also receiving a synthetic DMARD. To be eligible patients had to demonstrate stable low disease activity DAS less than . for over three months. Patients with serious concomitant illness or those taking highdose steroids more than mg prednisolone daily were excluded.  Of the  patients who reduced then stopped their TNFi after six months   succeeded without flaring and their final mean DAS score after stopping treatment was . demonstrating low disease activity.   Abstract Number SAT NOTES TO EDITORS  For further information on this study or to request an interview with the study lead please do not hesitate to contact the EULAR congress  Press Office in Room B of Fiera Roma during EULAR  or on  Email eularpressofficecohnwolfe.com mailtoeularpressofficecohnwolfe.com  Onsite tel             Twitter EULAR_Press httpstwitter.comeular_press  Youtube Eular Pressoffice About EULAR  The European League Against Rheumatism EULAR is an umbrella organisation which represents scientific societies health professional associations and organisations for people with rheumatic diseases throughout Europe.  EULAR aims to promote stimulate and support the research prevention and treatment of rheumatic diseases and the rehabilitation of those it affects.  With  scientific member societies  People with Arthritis and Rheumatism in Europe PARE organisations  health professionals associations and  corporate members EULAR highlights the importance of combating rheumatic diseases through both medical means and patient care.  EULAR  is set to be the biggest rheumatology event in Europe with around  scientists physicians allied health professionals and related audiences in attendance from more than  countries. Over the course of the congress there will be some  oral and just under  poster abstract presentations more than  sessions  lectures  poster tours and  invited speakers. To find out more about the activities of EULAR visit http"