Tapering biologic and conventional DMARD therapy in rheumatoid arthritis: current evidence and future directions.
Improvements in the control of inflammation in rheumatoid arthritis (RA) by conventional synthetic and biologic disease-modifying antirheumatic drugs (DMARDs) have led to a substantial change in the clinical outcomes of patients during the last 30 years. Current treatment can lead to sustained remission in some patients raising questions about the optimal management strategies in this subgroup of patients. Today, tapering of DMARDs and even their discontinuation appears as an interesting concept for achieving a more tailored and dynamic treatment approach of RA, especially in patients, who achieved full disease control by DMARD treatment. In this review article, current developments of DMARD tapering are discussed. The article provides an overview of existing studies on this topic and addresses new strategies to reach drug-free remission. Furthermore, concepts for defining patients eligible for DMARD tapering are described and potential future strategies in using biomarkers in predicting the risk for disease relapse after initiation of DMARD tapering are addressed. These findings are finally considered in light of the vision to achieve cure as an ultimate goal in patients with RA achieving full control of inflammation.
Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany.
Georg
G
Schett
Division of Rheumatic and Musculoskeletal Disease, Chapel Allerton Hospital, Leeds, UK.
Paul
P
Emery
Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany.
Yoshiya
Y
Tanaka
The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
Gerd
G
Burmester
Duke University Medical Center, Medical Research Service, Durham, North Carolina, USA.
David S
DS
Pisetsky
Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Esperanza
E
Naredo
Rheumatology Department, UPMC-GRC 08, Pierre Louis Institute for Epidemiology and Public Health-AP-HP, Pitie Salpetriere University Hospital, Paris, France.
Bruno
B
Fautrel
ARC: Amsterdam Rheumatology and Immunology Center.
Ronald
R
van Vollenhoven
D018501:Antirheumatic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D001688:Biological Products / Q000008:administration & dosage* / Q000627:therapeutic use; D035843:Biomedical Research / Q000379:methods / Q000639:trends; D019468:Disease Management; D004334:Drug Administration Schedule; D019317:Evidence-Based Medicine / Q000379:methods; D006801:Humans; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D012074:Remission Induction
D018501:Antirheumatic Agents; D001688:Biological Products
DMARDs (synthetic); Inflammation; Rheumatoid Arthritis