title: Optimizing the expediency of TNFi in rheumatoid arthritis: offering a TNFi holiday in patients having reached low-disease activity in the maintenance phase.
abstract: BACKGROUND
  The treatment of rheumatoid arthritis (RA) has been revolutionized since the introduction of biological disease-modifying antirheumatic drugs such as tumour necrosis factor alpha inhibitors (TNFi), and clinical remission has become a realistic target in the treatment strategy. Discontinuation strategies of TNFi therapy after reaching sustained remission or low-disease activity (LDA) have been emerging. These strategies are important considering the risk-benefit profile of TNFi, as well as looking at them from a cost-economic point of view.
  
  
  METHODS
  This article presents an overview of recent major studies on TNFi withdrawal, and tapering and about the safety of doing so.
  
  
  CONCLUSIONS
  Although data are still limited, tapering or discontinuing TNFi in some RA patients may well be possible, especially in the early RA patients who are methotrexate naive. Also, a substantial group of longer established RA patients can stop or taper TNFi, particularly when ultrasonography signals are negative. However, before making the decision of implementing it in the routine care for RA patients, more predictors for successful discontinuation are desired.
authors.affiliation: Radboud University Medical Center, Department of Rheumatology , POB 9101, 6500 HB Nijmegen , The Netherlands Tim.Jansen@Radboudumc.nl.
authors.forename: Iris L A
authors.initials: IL
authors.lastname: van Ingen
authors.forename: Femke
authors.initials: F
authors.lastname: Lamers-Karnebeek
authors.forename: Tim L
authors.initials: TL
authors.lastname: Jansen
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D018450:Disease Progression; D004334:Drug Administration Schedule; D006801:Humans; D008727:Methotrexate / Q000627:therapeutic use; D018365:Neoplasm, Residual; D012074:Remission Induction / Q000379:methods; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D028761:Withholding Treatment
chemical_list: D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha; D008727:Methotrexate
keywords: TNFi; TNFα; biological disease-modifying antirheumatic drugs; rheumatoid arthritis