Do we need guidelines to stop as well as to start biological therapies for rheumatoid arthritis?

After achieving low disease activity or remission, biological therapy might be stopped in rheumatoid arthritis patients, but information on whether and how this should be done is scarce. Successful discontinuation was highly variable since it was described in 0-97% of patients, in studies with different patient populations and follow-up durations between 12 weeks and over 7 years. In most studies, patients were required to have low disease activity or be in clinical remission for at least 6 months before biological therapy was discontinued. Significant joint damage progression in the first year after discontinuation was rare and functional ability was relatively stable in almost all patients in this year. In patients who had a disease flare, retreatment with biological therapy was successful in 70-100%. Mild infusion reactions after retreatment were described in a small number of patients. In conclusion, in the absence of a guideline for stopping biologicals in RA, we present a preliminary proposal that biological therapy can be stopped in many RA-patients after achieving low disease activity or remission for at least 6 months. Adequate monitoring of disease activity is essential, and retreatment appears to be safe and successful in many patients. Future research may further identify when and/or which patients are most likely to discontinue biological treatment successfully.