ReviewRheumatology and therapy2017
bDMARD Dose Reduction in Rheumatoid Arthritis: A Narrative Review with Systematic Literature Search.
Review in Rheumatology and therapy, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 2 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
22 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Enzyme-linked immunosorbent assays for monitoring TNF-alpha inhibitors and antibody levels in people with rheumatoid arthritis: a systematic review and economic evaluation.Health technology assessment (Winchester, England) · 2021Pooled it
- Down-titration and discontinuation strategies of tumour necrosis factor-blocking agents for rheumatoid arthritis in patients with low disease activity.The Cochrane database of systematic reviews · 2019Pooled it
- Effect of dose tapering policy on the prescription of advanced therapy for rheumatoid arthritis: a retrospective analysis of clinical and cost outcomes in Taiwan.Journal of comparative effectiveness research · 2026Article
- Dose reduction and discontinuation of non-tumor necrosis factor (TNF) biologic and targeted synthetic disease-modifying antirheumatic drugs (DMARDs) for people with rheumatoid arthritis in remission or low disease activity.The Cochrane database of systematic reviews · 2026Article
- Personalized dose reduction strategies for biologic disease-modifying antirheumatic drugs for treating axial spondyloarthritis: a clinical and economic evaluation with predictive modeling.BMC rheumatology · 2025Article
- Dose Modulation Strategies in Psoriatic Patients: Real-Life Pilot Comparison Between Risankizumab and Guselkumab up to 12 Months After Dose Spacing.Experimental dermatology · 2025Article
- Efficacy and Safety of the Bushen Quhan Zhiwang Decoction to Achieve Clinical Deep Remission in Rheumatoid Arthritis: Protocol for a Double-Blind, Randomized, Placebo-Controlled Trial.Journal of pain research · 2025Article
- Chinese guidelines for the diagnosis and treatment of rheumatoid arthritis: 2024 update.Rheumatology and immunology research · 2024Article
- On difficulties to define prognostic factors for clinical practice in rheumatoid arthritis.RMD open · 2024Review
- Prevalence and predictors of sustained remission/low disease activity after discontinuation of induction or maintenance treatment with tumor necrosis factor inhibitors in rheumatoid arthritis: a systematic and scoping review.Arthritis research & therapy · 2023Article
- Physical Function of RA patients Tapering Treatment-A Post Hoc Analysis of the Randomized Controlled RETRO Trial.Journal of clinical medicine · 2023Article
- Wangbi granule as a combination therapy to achieve clinical deep remission in rheumatoid arthritis: protocol for a multicenter, triple-blind, randomised, placebo-controlled trial.Chinese medicine · 2023Article
- Discontinuation of biologic DMARDs in non-systemic JIA patients: a scoping review of relapse rates and associated factors.Pediatric rheumatology online journal · 2022Article
- Clinical course of patients with rheumatoid arthritis who continue or discontinue biologic therapy after hospitalization for infection: a retrospective observational study.Arthritis research & therapy · 2022Observational
- Tumour necrosis factor inhibitor dose adaptation in psoriatic arthritis and axial spondyloarthritis (TAPAS): a retrospective cohort study.Rheumatology (Oxford, England) · 2022Article
- Tapering Biologic Therapy for Rheumatoid Arthritis: A Qualitative Study of Patient Perspectives.The patient · 2020Article
- Treat-To-Target and Treat-To-Budget in Rheumatoid Arthritis: Measuring the Value of Individual Therapeutic Interventions.Rheumatology and therapy · 2019Article
- Article
- Abatacept and tocilizumab tapering in rheumatoid arthritis patients: results of SONATA-a retrospective, exploratory cohort study.Rheumatology advances in practice · 2018Article
- Conceptual model for the health technology assessment of current and novel interventions in rheumatoid arthritis.PloS one · 2018Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionAlthough bDMARDs are effective in the treatment of RA, they are associated with dose-dependent side effects, patient burden, and high costs. Recently, many studies have investigated the possibility of discontinuing or tapering bDMARDs when patients have reached their treatment goal. The aim of this review is to provide a narrative overview of the existing evidence on bDMARD dose reduction and to provide answers to specific dose-reduction-related questions that are of interest to clinicians.
methodsWe systematically searched for relevant studies in four scientific databases. Furthermore, we screened the references of reviews and relevant studies.
resultsOur searches resulted in 45 original studies of bDMARD dose reduction in RA patients (15 RCTs and 30 observational studies). Current evidence shows that bDMARD dose reduction can be considered in all RA patients who achieve stable (e.g., ≥6 months) low disease activity or remission. The best strategies seem to be disease-activity-guided dose optimization and fixed dose reduction, since direct bDMARD discontinuation (without restarting) results in a high flare rate, worse physical functioning, and more joint damage. When tapering the bDMARD treatment of a patient, disease activity should be monitored closely, and if a flare occurs, the dose should be increased to the lowest effective dose. Current evidence shows that restarting bDMARD treatment is effective and safe. Unfortunately, no clear predictors of successful dose reduction have been identified so far.
conclusionThe current evidence and rising healthcare costs urge that dose reduction should be considered for eligible patients. However, the decision to start dose reduction should be made in shared decision-making. Future research should focus not only on a better understanding of the effects of dose reduction on clinical outcomes but also on the perspectives of patients and physicians as well as the implementation of this new treatment principle.
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