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For patients with rheumatoid arthritis (RA) with sustained low disease activity (LDA), structured tapering of biologic or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) is noninferior to treatment continuation for maintaining disease control over 24 weeks, according to a study published online Oct. 6 in Arthritis & Rheumatology.

Dong-Jin Park, MD, Ph.D., from Chonnam National University Medical School and Hospital in Gwangju, South Korea, and colleagues examined the efficacy and safety of a structured b/tsDMARD tapering strategy in patients with RA who had achieved sustained LDA in a 24-week, randomized, noninferiority trial. Patients with RA receiving stable-dose b/tsDMARDs and maintaining Disease Activity Score-28 using erythrocyte sedimentation rate-defined LDA for at least six months were randomly assigned to stepwise dose tapering or dose continuation (171 and 177 patients, respectively).

The researchers found that LDA was maintained in 89.6% and 88.2% of patients in the continuation and tapering groups, respectively, in the per-protocol population, with a risk difference of −1.43 percentage points (95% confidence interval, −8.9 to 5.23), meeting the noninferiority criterion. In the full analysis set, findings were similar. For most patients experiencing disease worsening, LDA was regained after protocol-guided treatment re-escalation during follow-up. Comparable secondary outcomes were seen between the groups, although some disease activity measures favored continuation. Adverse events occurred infrequently in both groups.

"With careful patient selection, close monitoring and timely treatment re-escalation when needed, dose tapering may reduce treatment burden while maintaining disease control and health-related quality of life," the authors write.

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