Rheumatoid arthritis drug dose tapering is helpful in some circumstances

People with rheumatoid arthritis who have low disease activity can achieve positive outcomes after reducing anti-TNF therapy dosages in certain circumstances, says new research published in the Cochrane Database of Systematic Reviews.
Although anti-TNF agents are effective in treating people with rheumatoid arthritis, they are sometimes associated with side effects as well as high costs. So experts from The Netherlands evaluated the benefits and harms of down-titration of anti-TNF agents by reducing drugs, discontinuing drugs or tapering the dose according to disease activity.

They looked at data from seven previous trials that involved 1,203 people receiving the anti-TNF therapies adalimumab and etanercept, to see if – compared with the usual standard of care – down titration affected disease activity, functioning, costs, safety and radiographic damage. Results showed that:
• Non-disease-activity-guided dose reduction of etanercept from 50mg weekly to 25mg weekly, after at least three to 12 months of low disease activity, was as effective as continuing the standard dose in terms of disease activity and functional outcomes. However, dose reduction was associated with small differences in radiological progression.
• Discontinuation of adalimumab and etanercept was shown to deliver inferior outcomes to continuation of treatment.
• Disease activity-guided dose tapering of adalimumab and etanercept seemed slightly inferior to continuation of treatment in terms of disease activity, with no difference in function.
A spokesperson from Arthritis Research UK comments:
“No-one wants to be on a drug – however effective – forever, and from the perspective of people with arthritis receiving these drugs, using lower doses could reduce the risk of serious side effects. Weaning people slowly off anti-TNF drugs or even just reducing their dose could have significant benefits.”

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