Rheumatoid arthritis treatment can be tapered successfully without flare-ups in some (but not all) people
Some people with rheumatoid arthritis who have been successfully treated with disease-modifying anti-rheumatic drug (DMARDs) or anti-TNFs may be able to taper their treatment without risking flare-ups in many cases, a research group claims in the Journal of Rheumatology.
Tapering means gradually reducing a treatment dose when disease has been brought under control. It’s a fine line as it can lead to flares if the condition becomes worse when the dosage is reduced.
So the team evaluated the risk of disease flares in people with rheumatoid arthritis who had tapered or stopped drug treatment after achieving remission or low disease activity. They analysed data from studies and trials in which the trend was assessed.
• Four studies looked at the use of synthetic DMARDs. Flare rates ranged from 8% at 24 weeks to 63% at four months after reducing the dose.
• Fifteen studies examined anti-TNFs. Flare rates in three studies involving the stopping of tocilizumab therapy measured at 41% after six months, 55% after one year and 87% also after one year.
• Three studies looked at reducing abatacept. Flare rates were 34% at one year, 41% at one year and 72% at six months.
“Results suggest that more than one-third of patients with rheumatoid arthritis with low disease activity or in remission may taper or stop DMARD treatment without experiencing a disease flare within the first year,” the researchers conclude. “Dose reduction of TNF blockers results in lower flare rates than stopping and may be non-inferior to continuing full dose. Radiological progression after treatment de-escalation remains low, but may increase slightly.”
Katherine Free, a research liaison and communications manager comments:
“Weaning people slowly off anti-TNF drugs, or even just reducing their dose, could have significant benefits to patients and reduce the risk of serious side effects. However, people with rheumatoid arthritis should note that dose tapering is still at an experimental stage, and they should not consider coming off their medication without discussing the possibility with their GP and rheumatologist first.”
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Image credit: Pedro Moura Pinheiro
