Table 1.
Overview of tapering studies
| Author | Study design | Disease | Gender (%, female) |
Biological treatment, add-on medication |
Criteria for inactive disease/remission | Criteria for start of tapering/discont. | Reported strategy of treatment tapering/discont. | Patients started tapering/discont. (n) | Patients with successful tapering (n) | Patients with successful discont. (n) | Follow- up time |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Vastert et al. [19] | Prospective cohort study | sJIA | 35% | Anakinra 2 mg/kg daily, max. 100 mg daily, no cDMARDs | Wallace criteria or Adapted ACR Pedi 90 response | Inactive disease or adapted ACR Pedi 90 responses at 3 months |
Alternate-day regimen for 1 month, followed by discont., 2nd tapering attempt 3–6 months later |
15 |
7 (first attempt), plus additional 4 (second attempt) |
11 |
at least 12 months, mean follow-up 2.67 years (1-4.5 years) |
| Ter Haar et al. [18] | Prospective cohort study | sJIA | 40% | Anakinra 2 mg/kg daily (max. 100 mg daily) (incomplete response: 4 mg/kg daily; max 200 mg daily), no cDMARDS | Wallace criteria | Inactive disease at 3 months | Alternate-day regimen for 1 month, followed by discont., | 33 | 31 | 18 | Up to 5 years |
| Quartier et al. [17] | IIIb/IV Open-label RCT | sJIA | 52% | Canakinumab 4 mg/kg q4w, no cDMARDs | Wallace criteria | Inactive disease for 6 months |
Arm 1: dose reduction three steps approach (each 24 weeks): 4 mg/kg/q4w to 2 mg/kg/q4w to 1 mg/kg/q4w to discontinuation Arm 2: interval prolongation three steps approach (each 24 weeks): 4 mg/kg/q4w to 4 mg/kg/q8w to 4 mg/kg/q12w to discontinuation |
Arm 1 38 Arm 2 37 |
Arm 1 27/26/17* Arm 2 31/30/8* *step 1/2/3 |
Arm 1 17 Arm 2 8 |
24 weeks |
| Kostik et al. [16] | Retro-spective obser-vational study | sJIA | 57% | Tocilizumab 12 mg/kg (< 30 kg) or 8 mg/kg (≥ 30 kg) q2w or q4w, add-on cDMARDs | Wallace criteria | Inactive disease for ≥ 12 months | Interval prolongation up to q5w for 3–4 months, then q6w for 3 months, if no clinical and laboratory signs of disease activity treatment was discontinued | 7 | 7 (of these 3 with MTX) | 7 (of these 3 with MTX) |
No MTX: 1078 days (IQR 848–1217), MTX: 918 days (IQR 508–1078) |
Abbreviations: cDMARDs conventional Disease Modifying Antirheumatic Drugs, discount. discontinuation, sJIA systemic juvenile idiopathic arthritis, mg milligram, kg kilogram, ACR Pedi 90 responses American College of Rheumatology Pediatric Response Criteria 90, q4w every 4 weeks; q8w every 8 weeks, q12w every 12 weeks, RCT randomized controlled trial, MTX methotrexate, IQR interquartile ranges