Stepwise dose reduction and discontinuation of biological disease-modifying anti-rheumatic drugs (bDMARD) in rheumatoid arthritis: a prospective cohort study of flare-free population, flares, and predictive markers
Authors' conclusion
Tapering bDMARD may maintain disease control short-term, but discontinuation increases flare risk.
Study context
- Population
- Patients with stable rheumatoid arthritis (RA) in clinical remission for ≥ 6 months on bDMARD41 advanced to Phase 2
- Exposure
- Stepwise bDMARD dose reduction and discontinuation vs continued standard therapy
- Outcome
- Flare-free population rate
- Follow-up
- 12 months (Phase 1)
Methodological detailsmatched controls, stepwise dose reduction then discontinuation (Phase 1, Phase 2)
- Matched controls
- Stepwise dose reduction then discontinuation (Phase 1, Phase 2)
Main finding
As reported in the abstract
Observational data: associations, not effects.
Further findings
| Outcome | Reduction | Control | HR (95% CI) | P value | |
|---|---|---|---|---|---|
| Flare-free population rate after bDMARD discontinuation (Phase 2) · 24 months | 52.5% | 86.6% | 4.6 (2.2–11.0) | P < 0.001 | |
| 0.050.21520Hazard ratio (log scale) |
- Flare-free population rate after bDMARD discontinuation (Phase 2) — Flares after bDMARD discontinuation (Phase 2)
- 47.5%
Gray-scale US findings as predictor of flare during dose reduction (Phase 1)
- OR
- 1.06
- Wald χ²
- 2.3
- p
- P = 0.04
Predictors of flare in Phase 2
- Power Doppler scores and ACPA-positivity were predictive of flares; concomitant MTX use reduced flare risk
Safety
Adverse events leading to discontinuation (Phase 1)
- Rare in both groups
Serious adverse events (Phase 2)
- Infrequent; occurred only in the control group
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Stepwise dose reduction and discontinuation of bDMARD in rheumatoid arthritis: a prospective cohort study of flare-free population, flares, and predictive markers. Arthritis Res Ther. Published 4 November 2025. doi:10.
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