Comparative efficacy and safety of disease-modifying antirheumatic drugs tapering strategies in sustained-remission rheumatoid arthritis: Systematic review and network meta-analysis
Authors' conclusion
Gradual bDMARD dose reduction while maintaining background cDMARD as backbone therapy showed the most favourable comparative flare profile, whereas bDMARD discontinuation was associated with a substantially higher flare risk.
Study context
- Population
- Adults with rheumatoid arthritis (RA) in remission (≥6 months)
- Participants
- 3,115 adults19 studies
- Comparison
- DMARD de-escalation strategies vs maintenance therapy in RA in sustained remission
- Outcome
- Flare risk
Methodological detailsfrequentist random-effects network meta-analysis (NMA), consistency model, ranking by P-scores, CINeMA confidence assessment, sensitivity analysis including complete DMARD withdrawal (N2)
- Frequentist random-effects NMA
- Consistency model
- Ranking by P-scores
- CINeMA confidence assessment
- Sensitivity analysis including complete DMARD withdrawal (N2)
Pooled result
As reported in the abstract
Relative risk (95% CI)
N4vs N0CINeMA confidence moderate
1.17(0.76–1.82)
N3vs N0CINeMA confidence high
3.06(1.81–5.16)
N3vs N4
2.61(1.44–4.72)
Further pooled results
| Outcome | RR (95% CI) | |
|---|---|---|
| Flare risk, any DMARD taperingvs continued therapy (overall) | 1.94 (1.30–2.89) | |
| 0.20.5125Relative risk (log scale) |
Original publication
Comparative efficacy and safety of disease-modifying antirheumatic drugs tapering strategies in sustained-remission rheumatoid arthritis: Systematic review and network meta-analysis. Semin Arthritis Rheum. Published 19 September 2026. doi:10.
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