In two trials, most patients with RA in remission who tapered csDMARD or TNF inhibitor drugs to withdrawal experienced flares within 3 years.
in remission who tapered and then fully stopped either conventional synthetic disease-modifying antirheumatic drug or tumor necrosis factor inhibitor therapy experienced more disease flares than those who received stable dose treatment in an open-label, randomized trial., 80% of patients taking stable doses of only csMARDs remained flare-free compared with 38% in another treatment arm taking only csDMARDs who tapered to a half dose and then discontinued all after 1 year.
Both the ACR and the European Alliance of Associations for Rheumatology recommendations for the management of RA stated that tapering DMARDs can be considered for patients who have sustained remission, but they do not mention discontinuing medication entirely. O'Dell emphasized that the takeaway from these results should not be to avoid tapering medication because of flare risk but instead a tailored approach — something that is not possible with a study protocol — is needed.
A total of 139 participants in the csDMARD-only arms completed 3 years of follow-up, with 68 in the stable-dose group, 36 in the half-dose group, and 35 in the half-dose tapering to withdrawal group. In the TNF inhibitor arms, a total of 80 patients completed the 3-year follow-up. By the end of 3 years, 75% of the tapering group experienced a disease flare compared with 15% of the stable TNF inhibitor group. Most patients regained DAS remission status in the next clinic visit following a flare, the authors reported. During the study, 23% of the tapering group and 13% of the stable TNF inhibitor group used systemic glucocorticoids.
RA - Rheumatoid Arthritis Rheumatoid Arthritis (RA) Remission Anti-Tnf Anti-Tumor Necrosis Factor Anti-Tumour Necrosis Factor Disease-Modifying Antirheumatic Drugs Dmards DMARD Addiction Arthritis Joint Inflammation Drug Withdrawal Hospitals Nebraska Biologic Therapy Biologics Europe European Glucocorticosteroids Glucocorticoid Therapy Glucocorticoid Grant Tumor
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