Review
Efficacy and safety of down-titration versus continuation strategies of biological disease-modifying anti-rheumatic drugs in patients with rheumatoid arthritis with low disease activity or in remission: a systematic review and meta-analysis
M. Jiang1, F. Ren2, Y. Zheng3, R. Yan4, W. Huang5, N. Xia6, L. Luo7, J. Zhou8, L. Tang9
- Department of Rheumatology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
- Department of Rheumatology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
- Department of Rheumatology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
- Department of Rheumatology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
- Department of Rheumatology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
- Department of Rheumatology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
- Department of Rheumatology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
- Department of Rheumatology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
- Department of Rheumatology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China. hopetang@163.com
CER9440
2017 Vol.35, N°1
PI 0152, PF 0160
Review
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PMID: 27749238 [PubMed]
Received: 18/03/2016
Accepted : 25/07/2016
In Press: 07/09/2016
Published: 26/01/2017
Abstract
OBJECTIVES:
To evaluate the efficacy and safety of down-titration (dose reduction/tapering) strategies compared with continuation of biological disease-modifying anti-rheumatic drugs (DMARDs) in patients with rheumatoid arthritis (RA) who achieved and maintained low disease activity or remission.
METHODS:
We searched the following electronic database up to March 2016: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and conference proceedings of the American College of Rheumatology (ACR) and European League against Rheumatism (EULAR). Our meta-analysis included randomized controlled trials (RCTs) of RA patients with low disease activity or in remission that compared down-titration treatment with continuation treatment. Data on flare, defined as a 28-joint Disease Activity Score of ≥3.2, had to have been reported. Outcomes on efficacy or safety were collected.
RESULTS:
Of 1136 references identified, five RCTs (total, 771 participants) were included. The incidence of disease relapse in the down-titration and continuation groups was similar (risk ratio (RR)=1.14, 95% CI=0.88–1.49). There was no statistical difference in the number of serious adverse events (RR=1.15, 95% CI=0.53–2.49). Withdrawals due to inefficacy or toxicity were similar between groups and no clinically meaningful difference in efficacy outcomes was observed by continuation treatment.
CONCLUSIONS:
Our findings indicated that continuing a standard dose of biological DMARDs in patients with low disease activity conveyed no significant benefit as compared with down-titration therapy, suggesting that a down-titration strategy is as effective as a continuation strategy. Since the number of trials meeting the criteria for this meta-analysis was relatively low, future analyses with additional prospective RCTs are required to compare other biological agents and evaluate the long-term efficacy of these two strategies.
