Drug-free remission is a treatment goal in rheumatoid arthritis that can be achieved by tapering and discontinuation of biologic DMARDs. However, newly published real-world evidence suggests that DMARD discontinuation occurs less frequently than results of clinical trials suggest, so it is important to question what the ultimate goal of treatment should be.
This is a preview of subscription content, access via your institution
Access options
Access Nature and 54 other Nature Portfolio journals
Get Nature+, our best-value online-access subscription
$29.99 / 30 days
cancel any time
Subscribe to this journal
Receive 12 print issues and online access
$209.00 per year
only $17.42 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
References
Smolen, J. S. et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update. Ann. Rheum. Dis. 82, 3–18 (2023).
Aga, A. B. et al. Time trends in disease activity, response and remission rates in rheumatoid arthritis during the past decade: results from the NOR-DMARD study 2000–2010. Ann. Rheum. Dis. 74, 381–388 (2015).
Combe, B. et al. Current favourable 10-year outcome of patients with early rheumatoid arthritis: data from the ESPOIR cohort. Rheumatology (Oxford) 60, 5073–5079 (2021).
Fautrel, B. & Den Broeder, A. A. De-intensifying treatment in established rheumatoid arthritis (RA): Why, how, when and in whom can DMARDs be tapered? Best Pract. Res. Clin. Rheumatol. 29, 550–565 (2015).
Vinson, D. et al. Impact of tapering targeted therapies (bDMARDs or JAKis) on the risk of serious infections and adverse events of special interest in patients with rheumatoid arthritis or spondyloarthritis: a systematic analysis of the literature and meta-analysis. Arthritis Res. Ther. 22, 97 (2020).
Sigaux, J. et al. Sustainability of TNF-blocker tapering in rheumatoid arthritis over 3 years: long-term follow-up of the STRASS (Spacing of TNF-blocker injections in Rheumatoid ArthritiS Study) randomised controlled trial. RMD Open 3, e000474 (2017).
Valero, M. et al. Factors associated with discontinuation of biologics in patients with inflammatory arthritis in remission: data from the BIOBADASER registry. Arthritis Res. Ther. 25, 86 (2023).
Schett, G. et al. Tapering biologic and conventional DMARD therapy in rheumatoid arthritis: current evidence and future directions. Ann. Rheum. Dis. 75, 1428–1437 (2016).
Akdemir, G. et al. Clinical and radiological outcomes of 5-year drug-free remission-steered treatment in patients with early arthritis: IMPROVED study. Ann. Rheum. Dis. 77, 111–118 (2018).
Markusse, I. M. et al. Long-term outcomes of patients with recent-onset rheumatoid arthritis after 10 years of tight controlled treatment: a randomized trial. Ann. Intern. Med. 164, 523–531 (2016).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The author declares no competing interests.
Rights and permissions
About this article
Cite this article
Fautrel, B. Biologics in rheumatoid arthritis: a lifetime treatment or possibility of drug holidays?. Nat Rev Rheumatol 19, 611–612 (2023). https://doi.org/10.1038/s41584-023-01005-4
Published:
Issue Date:
DOI: https://doi.org/10.1038/s41584-023-01005-4
