• Samuel L Whittle, Vanessa Glennon, Renea V Johnston, Jodie C Avery, J Simon Bell, Sue E Brennan, Christopher Fong, Pravin Hissaria, Ben Horgan, Sean O'Neill, Huai Leng Pisaniello, Lyndal Trevena, Glen A Whittaker, Anita Wluka, and Rachelle Buchbinder.
• Rheumatology Unit, Queen Elizabeth Hospital, Adelaide, South Australia, Australia.
• Intern Med J. 2022 Oct 1; 52 (10): 179918051799-1805.

AbstractBiological and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARD) have been an important advance in the management of inflammatory arthritis, but are expensive medications, carry a risk of infection and other adverse effects, and are often perceived as a burden by patients. We used GRADE methodology to develop recommendations for dose reduction and discontinuation of b/tsDMARD in people with rheumatoid arthritis (RA), axial spondyloarthritis (AxSpA) and psoriatic arthritis (PsA) who have achieved a low disease activity state or remission. The recommendations form part of the Australian Living Guideline for the Pharmacological Management of Inflammatory Arthritis, an NHMRC-endorsed 'living' guideline, in which recommendations are updated in near real-time as new evidence emerges. Conditional recommendations were made in favour of dose reduction in RA and AxSpA but not in PsA. Abrupt discontinuation of b/tsDMARD is not recommended in any of the three diseases.© 2022 Royal Australasian College of Physicians.

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