Down-titration and discontinuation strategies of tumor necrosis factor-blocking agents for rheumatoid arthritis in patients with low disease activity

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

“…Our meta-analysis reveals no statistically significant increase in the risk of losing LDA, even though there was a significant increase in the risk of losing remission, after bDMARD dose reduction in comparison with the continuation of the initial treatment regimen. These results differ from those of the meta-analysis published by the Cochrane Library,12 which showed a lower probability of maintaining LDA when bDMARD doses were reduced (RR (95% CI)=0.87 (0.78 to 0.98), P=0.02). These differences might be explained by the fact that our meta-analysis includes 17 articles, 9 of which were not available when the Cochrane Library undertook its systematic analysis of the literature in September 2013.…”

“…These results reinforce those of the meta-analysis published by the Cochrane Library,12 in which there was a reduction in the probability of maintaining LDA in case of anti-TNF discontinuation (RR (95% CI)=0.43 (0.27 to 0.68), P=0.00004). Our meta-analysis reveals no statistically significant increase in the risk of losing LDA, even though there was a significant increase in the risk of losing remission, after bDMARD dose reduction in comparison with the continuation of the initial treatment regimen.…”

“…A systematic analysis of the Cochrane Library12 performed in 2014, including seven studies (1203 patients) focused on two antitumour necrosis factors (TNFs) (adalimumab and etanercept), estimated that anti-TNF tapering appears as effective as continuing anti-TNFs in terms of clinical effectiveness and disability, although there is minimal radiographic progression. However, discontinuing anti-TNF was associated with worse functional and radiographic outcomes.…”

Strategy for Dose Reduction and Discontinuation of Biological Agents in Rheumatoid Arthritis Remission

“…В настоя-щее время в ревматологическую практику ак-тивно внедряется принцип «лечения до дос-тижения цели» (Treat to target), который пред-усматривает раннее назначение эффективной терапии и своевременную ее коррекцию с учетом динамики количественных показате-лей воспалительной активности, с тем чтобы добиться ремиссии или низкой активности заболевания в течение 6 мес от постановки диагноза [4]. Понятие «пожизненная тера-пия» при РА было выделено в связи с возмож-ностью развития обострения болезни при от-мене БПВП [5]. В настоящее время примене-ние ГИБП позволяет у многих больных дос-тичь низкой активности заболевания и в ряде случаев длительной ремиссии РА, однако во-прос «снижения дозы/отмены» применяемого препарата для оптимизации соотношения «безопасность/риск обострения», а также «стоимость/эффективность» данных медика-ментов остается предметом дискуссий [6][7][8].…”

Comment on l’Ami et al titled ’Successful reduction of overexposure in patients with rheumatoid arthritis with high serum adalimumab concentrations: an open-label, non-inferiority, randomised clinical trial'

“…In light of recent data from DRESS and STRASS, it seems that tapering is feasible in patients with lower trough levels 2. Also, the reason to choose tapering only by 33%, when clinical trials have already demonstrated that further tapering up to cessation is successful in the majority of patients, is unclear 3. Finally, there is no comparison with state-of-the-art usual care, being treat-to-target tapering using only a disease activity measure like DAS28.…”