Temporal Patterns of Outcomes After DMARD Tapering or Withdrawal in Rheumatoid Arthritis With Sustained Disease Control: A Systematic Review and Meta-Analysis.
Xiaoyan Zhang, Rajan Kumar Pandey, Xi Luo et al.
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In 30 seconds
This systematic review and meta-analysis evaluated the effects of DMARD tapering and withdrawal in patients with rheumatoid arthritis (RA) who had sustained disease control. Analyzing 27 studies with 5262 participants, the study found that tapering increased flare risk (RR 1.56) and withdrawal significantly increased flare risk (RR 2.23), particularly with biologic DMARDs. Both strategies were associated with potential radiographic progression.
Key findings
- Any DMARD tapering increased flare risk overall (RR 1.56, 95% CI 1.26-1.98).
- DMARD withdrawal substantially increased flare risk (RR 2.23, 95% CI 1.83-2.94).
- Tapering and withdrawal promoted radiographic progression at 9-18 months and > 18 months.
- Neither tapering nor withdrawal reduced adverse events.
Why it matters
Understanding the risks associated with DMARD tapering and withdrawal is crucial for clinicians managing RA, as these strategies may lead to increased disease flares and radiographic progression, impacting long-term patient outcomes.