[Rheumatoid arthritis]

Abstract

Therapy reduction in rheumatoid arthritis (RA) is still a challenge for physicians as well as for patients. Effective therapy with subsequent achievement of low disease activity or even remission is achievable for numerous patients using currently available treatment options. Therapy discontinuation has therefore become a hot topic and the risk of exacerbation of well-controlled RA must be weighed against the medical and economic benefits of reducing or even discontinuing therapy. This article gives a review of data regarding tapering of therapy in RA, focusing on conventional disease-modifying antirheumatic drug (DMARD) monotherapy, reduction of conventional therapy under continuing therapy with biologics and discontinuation of biologics. Important influencing factors for a safe and successful tapering procedure appear to be disease activity, disease duration and the tapering process itself (i.e. gradual dose reduction vs. abrupt discontinuation). Additionally, the so-called nocebo effect should also be taken into consideration for interpretation of drug tapering studies.

Keywords: Discontinuation; Dosage; Nocebo effect; Reduction; Therapy.