• Rev Med Interne · Apr 2017

    Review

    [Discontinuation or tapering strategies of biologics in rheumatoid arthritis in remission].

    • A Mallick, B Fautrel, F Sagez, C Sordet, R-M Javier, H Petit, E Chatelus, N Rahal, J-E Gottenberg, and J Sibilia.
    • Service de rhumatologie, centre national de référence maladies auto-immunes et systémiques rares, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France. Electronic address: auriane.mallick@hotmail.fr.
    • Rev Med Interne. 2017 Apr 1; 38 (4): 256-263.

    AbstractThe arrival of new drugs and new therapeutic strategies allowed to reach sustained remission in an increasing number of patients with rheumatoid arthritis. The study of biologic disease-modifying anti-rheumatic drugs (bDMARDs) adaptation strategies is a need to optimize the benefit/risk balance and cost/effectiveness ratio of these molecules. Current recommendations such as EULAR 2016 propose tapering bDMARDs, especially when combined with a csDMARD, when the patient is in remission after stopping persistent glucocorticoids. The analysis of literature comprising 22 studies shows that a bDMARD adaptation is possible in established rheumatoid arthritis when clinico-biological and ultrasound remission is maintained over six months. Priority should be given to a progressive tapering strategy doses controlled by disease activity while maintaining "tight control" to identify and effectively treat a relapse, a retreatment being usually favorable.Copyright © 2016 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier SAS. All rights reserved.

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