Risk of disease flare and clinical reversibility following discontinuation versus dose reduction of biological DMARDs in Rheumatoid arthritis: A systematic review and meta-analysis
Pooled result · Disease flareResult — go to the resultPooled relative risk 2.13 95% CI 1.74–2.61Authors' conclusion
Gradual dose reduction is a safer initial de-escalation strategy than complete discontinuation for maintaining remission in RA. Although stopping bDMARDs more than doubles the risk of flare, the clinical consequences are largely reversible.
Study context
- Population
- Patients with rheumatoid arthritis (RA) in stable remission (randomized controlled trials (RCTs) published from inception until February 1, 2026)10 RCTs + 1 extension study
- Participants
- 2,861 patients
- Comparison
- Complete discontinuation of biological disease-modifying antirheumatic drugs (bDMARDs) vs dose reduction or maintenance
- Outcome
- RR of disease flare
Methodological detailsrandom-effects model
- Random-effects model
Pooled result
Disease flare
Pooled relative risk
2.13
95% CI 1.74–2.61
P < 0.00001
Discontinuationvs Dose reduction or maintenance
Pooled RR 2.13 (95% CI 1.74–2.61); P < 0.00001
As reported in the abstract
Further pooled results
| Outcome | RR (95% CI) | |
|---|---|---|
| Flare by disease duration (subgroup)Discontinuationvs Dose reduction or maintenanceEarly RA (<2 years) | 1.62 (1.25–2.10) | |
| Flare by disease duration (subgroup)Discontinuationvs Dose reduction or maintenanceEstablished RA | 2.31 (1.89–2.82) | |
| 0.20.5125Relative risk (log scale) |
- Flare by disease duration (subgroup) — Significant interaction
- P = 0.007
Capture rate on re-initiating therapy
- Pooled capture rate
- 87.5% (95% CI: 82.4-91.6)
- Median time to clinical recovery
- 12.4 weeks
Radiographic progression (vSHS)
- Minimal; primarily driven by cumulative disease activity during flares rather than the tapering strategy itself
Publication bias
- No significant publication bias (Egger's test)
- P = 0.456
Original publication
Risk of disease flare and clinical reversibility following discontinuation versus dose reduction of biological DMARDs in Rheumatoid arthritis: A systematic review and meta-analysis. Semin Arthritis Rheum. Published 3 June 2026. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →