Piero Ruscitti1, Luigi Sinigaglia2, Massimiliano Cazzato3, Rosa Daniela Grembiale4, Giovanni Triolo5, Ennio Lubrano6, Carlomaurizio Montecucco7, Roberto Giacomelli1. 1. Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila. 2. Division of Rheumatology, Gaetano Pini Institute, Milan. 3. Departement of Rheumatology, University of Pisa, Pisa. 4. Department of Health Sciences, University of Catanzaro 'Magna Graecia', Catanzaro. 5. Department of Internal Medicine, University of Palermo, Palermo. 6. Department of Medicine and Health Science 'Vincenzo Tiberio', University of Molise, Campobasso. 7. Rheumatology and Translational Immunology Research Laboratories (LaRIT) and Biologic Therapy Unit, IRCCS Policlinico San Matteo Foundation/University of Pavia, Pavia, Italy.
Abstract
Objectives: To review the available evidence concerning the possibility of discontinuing and/or tapering the dosage of TNF inhibitors (TNFi) in RA patients experiencing clinical remission or low disease activity. Methods: A systematic review of the literature concerning the low dosage and discontinuation of TNFi in disease-controlled RA patients was performed by evaluation of reports published in indexed international journals (Medline via PubMed, EMBASE), in the time frame from 8 April 2013 to 15 January 2016. Results: We analysed the literature evaluating the efficacy and the safety of two different strategies using TNFi, decreasing dosage or discontinuation, in patients experiencing clinical remission or low disease activity. After the analysis of online databases, 25 references were considered potentially relevant and 16 references were selected. The majority of data concerned etanercept and adalimumab. Results suggested the induction of stable clinical remission or low disease activity by using TNFi followed by a dosage tapering and/or discontinuation of such drugs may be associated with the maintenance of a good clinical response in a subset of patients affected by early disease. Conclusion: RA patients treated early with TNFi and achieving their therapeutic clinical targets seem to maintain their clinical response after tapering or discontinuing TNFi. These data may allow physicians a more dynamic and tailored management of RA patients.
Objectives: To review the available evidence concerning the possibility of discontinuing and/or tapering the dosage of TNF inhibitors (TNFi) in RApatients experiencing clinical remission or low disease activity. Methods: A systematic review of the literature concerning the low dosage and discontinuation of TNFi in disease-controlled RApatients was performed by evaluation of reports published in indexed international journals (Medline via PubMed, EMBASE), in the time frame from 8 April 2013 to 15 January 2016. Results: We analysed the literature evaluating the efficacy and the safety of two different strategies using TNFi, decreasing dosage or discontinuation, in patients experiencing clinical remission or low disease activity. After the analysis of online databases, 25 references were considered potentially relevant and 16 references were selected. The majority of data concerned etanercept and adalimumab. Results suggested the induction of stable clinical remission or low disease activity by using TNFi followed by a dosage tapering and/or discontinuation of such drugs may be associated with the maintenance of a good clinical response in a subset of patients affected by early disease. Conclusion:RApatients treated early with TNFi and achieving their therapeutic clinical targets seem to maintain their clinical response after tapering or discontinuing TNFi. These data may allow physicians a more dynamic and tailored management of RApatients.
Authors: Matthijs S van der Leeuw; Marianne A Messelink; Janneke Tekstra; Ojay Medina; Jaap M van Laar; Saskia Haitjema; Floris Lafeber; Josien J Veris-van Dieren; Marlies C van der Goes; Alfons A den Broeder; Paco M J Welsing Journal: Arthritis Res Ther Date: 2022-03-23 Impact factor: 5.156