Table 4.

Points to be considered for treatment discontinuation/tapering in patients on biologic DMARDs

• Study designs consideration: complete withdrawal or dose tapering or extension of the interval between administrations of biologic DMARDs

• Any predictors of response following therapy discontinuation or tapering identified

• Goal of treatment before withdrawal: remission or LDA or other and the definitions used for the goals

• Duration required for the patients to achieve goal before a given biologic DMARD was discontinued

• Duration of RA among the enrolled patients

• Type of prior treatments given to enrolled patients

• Disease activity level prior to biologic DMARD therapy initiation and the extent of improvement achieved by the therapy before discontinuation

• Mode of discontinuation of drugs including corticosteroids, NSAIDs and chemical DMARDs which usually accompany biologic DMARDs

• Criteria of defining success vs. failure of treatment; DAS, simple disease activity index (SDAI), clinical DAI (CDAI), radiological tissue damage assessment or functional status assessed by health assessment questionnaire

• Follow up duration

• Effect of treatment resumption; response achieved and the time required for it

• Incidence of serious flaring such as joint damage and mobility impairment among patients who discontinued or reduced therapy