SynthesisFrontiers in medicine2025
Efficacy of withdrawal or tapering of bDMARDs vs. standard regimen in axial spondyloarthritis patients: systematic review and meta-analysis informing the update of the Spanish Society of Rheumatology Guideline.
Synthesis in Frontiers in medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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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.
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Who cites it
1 citing paper in PubMed.
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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Objectives: To assess efficacy of withdrawal or tapering biologic disease-modifying antirheumatic drugs (bDMARDs) vs. maintaining a standard regimen in patients with axial spondyloarthritis (axSpA) to sustain remission. Methods: We conducted a systematic review of randomized controlled trials (RCTs) through July 2025, comparing treatment discontinuation or tapering against standard bDMARDs regimens in axSpA. We included RCTs of axSpA patients randomized to treatment interruption or tapering compared with standard treatment regimens. Outcomes measures included remission or flare measured by Ankylosing Spondylitis Disease Activity Score (ASDAS), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and acute phase reactants. We rated the certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. We presented dichotomous outcomes as risk ratios (RR) with their 95% confidence intervals (CI). We used a random-effect model to perform a pooled analysis. Results: Eight RCTs involving 1,384 participants were analyzed. For those in sustained remission >6 months, withdrawal led to a significantly lower rate of inactive disease state (RR 0.58, CI 0.45-0.76; high certainty) and increased risks of flare (RR 1.79, CI 1.34-2.38; high certainty) and partial flares (RR 1.57, CI 1.25-1.97; high certainty) compared to the standard regimen. Patients with short-term remission <6 months and treatment withdrawal experienced significantly higher rates of flares (RR 0.41 CI 0.23-0.72, low certainty) and increased disease activity (RR 0.36 CI 0.15-0.86, low certainty). Tapering in 211 patients showed non-significant risk reductions in maintaining remission or low disease activity (RR 0.89, CI 0.66-1.18; moderate certainty). Conclusion: Treatment withdrawal reduces the likelihood of maintaining inactive or low disease activity. Tapering does not significantly compromise the maintenance of remission or low disease activity offering a safer alternative to complete treatment withdrawal.
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