Predicting drug-free remission in rheumatoid arthritis: the Biomarkers of Remission in Rheumatoid Arthritis (BioRRA) Study

Sustained remission is now an achievable goal in rheumatoid arthritis (RA) using modern treat-to-target regimens of disease-modifying anti-rheumatic drugs (DMARDs). Recent studies have demonstrated that up to half of patients in remission can discontinue DMARDs and maintain drug-free remission (DFR), with consequent benefits of avoidance of drug toxicity and the need for regular and expensive safety monitoring. However, there are currently no reliable biomarkers that can predict DFR prior to withdrawal of DMARDs. Aim: As part of a wider study of DMARD withdrawal (the BioRRA study), we aimed to identify predictors of time-to-flare following DMARD cessation using whole-genome bulk RNA sequencing data from circulating CD4+ T cells. Overall design: Circulating CD4+ T cells were isolated from whole blood at baseline in 44 patients with RA in remission immediately prior to conventional synthetic DMARD cessation. Following total RNA extraction and poly-A selection, mRNA was sequenced using an Illumina NextSeq 500.