Discontinuation or tapering strategies of biologics in rheumatoid arthritis in remission

作者：Mallick A^*; Fautrel B; Sagez F; Sordet C; Javier R M; Petit H; Chatelus E; Rahal N; Gottenberg J E; Sibilia J

来源：Revue de Medecine Interne, 2017, 38(4): 256-263.

DOI：10.1016/j.revmed.2016.12.014

• Rheumatoid arthritis
• Remission
• Treatment tapering
• Dose reduction
• Spacing

The arrival of new drugs and new therapeutic strategies allowed to reach sustained remission in an increasing number of patients with rheumatoid arthritis. The study of biologic disease-modifying anti rheumatic drugs (bDMARDs) adaptation strategies is a need to optimize the benefit/risk balance and cost/effectiveness ratio of these molecules. Current recommendations such as EULAR 2016 propose tapering bDMARDs, especially when combined with a csDMARD, when the patient is in remission after stopping persistent glucocorticoids. The analysis of literature comprising 22 studies shows that a bDMARD adaptation is possible in established rheumatoid arthritis when clinico-biological and ultrasound remission is maintained over six months. Priority should be given to a progressive tapering strategy doses controlled by disease activity while maintaining "tight control" to identify and effectively treat a relapse, a retreatment being usually favorable.

• 出版日期2017-4