Tapering vs Discontinuation of bDMARDs in Rheumatoid Arthritis

Tapering doses of biologic disease-modifying antirheumatic drugs (bDMARDs) in patients with rheumatoid arthritis (RA) in stable remission or with low disease activity is preferred compared with discontinuation of bDMARDs, as it does not increase the risk for relapse or radiographic progression, according to a meta-analysis published in the Annals of the Rheumatic Diseases.

To determine the risk for losing remission, low disease activity, or radiographic progression when discontinuing or tapering bDMARDs compared with continuing the initial treatment regimen in patients with RA who are in remission or who have low disease activity, researchers conducted a systematic literature analysis using various databases and identified 13 published articles that could be used in their meta-analyses. 

Nine published articles comparing discontinuation of bDMARDs with continuation of treatment demonstrated an increased risk for losing remission (P <.0001) or low disease activity (P<.0001) and an increased risk for radiographic progression (P =.01) with discontinuing bDMARDs. Seven published articles and 4 abstracts comparing a bDMARD tapering strategy (decreasing dose or spacing strategy) with continuation of treatment demonstrated an increased risk for losing remission (P =.006) but no increased risk for losing low disease activity (P =.81) nor any increased risk for radiographic progression (P =.26) with tapering bDMARDs.

The researchers concluded that, “Our meta-analysis reveals that, in RA patients with remission or [low disease activity], discontinuation of bDMARDs leads to an increased risk of losing remission or [low disease activity] and radiographic progression, while tapering doses of bDMARDs does not increase the risk of relapse or radiographic progression, even though there is an increased risk of losing remission, in comparison with continuation of the initial bDMARD regimen.” Therefore, a dose reduction strategy of either lowering or spacing bDMARD doses may be preferred to discontinuation of treatment for patients with RA in stable remission or with low disease activity.

Reference

Henaux S, Ruyssen-Witrand A, Cantagrel A, et al. Risk of losing remission, low disease activity or radiographic progression in case of bDMARD discontinuation or tapering in rheumatoid arthritis: systematic analysis of the literature and meta-analysis. Ann Rheum Dis 2018;77:515-522.