title: [Tapering and termination of immunosuppressive treatment in spondyloarthritides (including psoriatic arthritis)].
abstract: BACKGROUND
  Immunomodulatory long-term treatment has also become the standard treatment for spondyloarthritides (SpA), including psoriatic arthritis (PsA); however, uncertainty exists about dose reduction or termination of treatment after remission or low disease activity.
  
  
  OBJECTIVE
  When is it possible to reduce medication or terminate treatment for SpA?
  
  
  METHODS
  An extensive non-systematic literature search was performed focusing on practice guidelines, systematic meta-analyses and clinical trials on medicinal long-term treatment and voluntary medication reduction in axial and peripheral SpA, including PsA.
  
  
  RESULTS
  The chances of drug-free remission after treatment with biologics for axial SpA and in PsA are low; however, in remission or a state of low disease activity reduction of the cumulative dosage of biologics can be successful in 53-100% of cases without a significant increase in disease activity. The current state and duration of remission, with or without comedication with nonsteroidal anti-inflammatory drugs (NSAID), extra-articular disease manifestations and the results of previous treatment attempts have to be carefully taken into consideration before elective dose reduction.
  
  
  CONCLUSIONS
  Reduction of long-term treatment is an individualized decision made jointly by patients and physicians. The risk of flares and especially of extra-articular disease manifestations needs to be weighed against the possible advantages of reduced medication. Maintainenance of mediction-free disease remission is too rare in SpA or PsA patients carefully selected for biologics treatment, to allow a later voluntary termination of therapy, without at least a prior cautious attempt at dose reduction.
authors.forename: G
authors.initials: G
authors.lastname: Scholz
authors.affiliation: Immunologie und Allergologie, Inselspital - Universitätsspital Bern, Universitätsklinik für Rheumatologie, Freiburgstr. 10, 3010, Bern, Schweiz. burkhard.moeller@insel.ch.
authors.forename: B
authors.initials: B
authors.lastname: Möller
mesh_terms: D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D016903:Drug Monitoring / Q000379:methods; D019317:Evidence-Based Medicine; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D013167:Spondylitis, Ankylosing / Q000175:diagnosis* / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents
keywords: Biologics; Disease activity; Dose reduction; Long-term treatment; Remission