Tapering conventional synthetic DMARDs towards sustained drug-free remission in rheumatoid arthritis

Rheumatoid arthritis is a chronic disease that often requires lifelong treatment. Management of patients with rheumatoid arthritis has improved due to timely treatment with disease-modifying antirheumatic drugs (DMARDs) aimed at sustained remission. As a result, rheumatoid arthritis has become a more controllable disease, in which clinical remission has become a reachable outcome for an increasing number of patients. When in remission, the benefits of treatment might not be balanced with the burden of taking the medication (including adverse events and costs), and tapering and discontinuation might be an attractive option for some patients. European Alliance of Associations for Rheumatology recommendations for the management of rheumatoid arthritis state that dose reduction can be considered for patients in remission. 1 Smolen JS Landewé RBM Bergstra S A et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update. Ann Rheum Dis. 2023; 82: 3-18 Crossref PubMed Scopus (325) Google Scholar Furthermore, sustained DMARD free remission is the best proxy for a cure. Effects of tapering conventional synthetic disease-modifying antirheumatic drugs to drug-free remission versus stable treatment in rheumatoid arthritis (ARCTIC REWIND): 3-year results from an open-label, randomised controlled, non-inferiority trialTwo conventional synthetic DMARD tapering strategies were associated with significantly lower rates of flare-free survival compared with stable conventional synthetic DMARD treatment, and the data do not support non-inferiority. However, drug-free remission was achiveable for a significant subgroup of patients. This trial provides information on risk and benefits of different treatment strategies important for shared decision making. Full-Text PDF