[Maintenance therapy for rheumatoid arthritis after remission following successful treatment using biologics]

Treatment of rheumatoid arthritis (RA) has been dramatically changed over the last few years mainly by the introduction of biologic agents. Several biologic agents have profound efficacy in patients with active RA, since these biologics target cytokines that is deeply involved in the pathogenesis of RA. The biologic agents have made it possible to inhibit the progression of structural damage and to introduce into remission. Because biologic agents are strong immunosuppressant and also quite expensive, questions arise whether it is possible to discontinue biologic agents in patients with good clinical response. No consensus has been established concerning this important clinical question until now, however, it may be possible to discontinue the injection in patients with early disease who successfully introduced into remission. In those patients with longstanding RA, even if patients are introduced into remission, it seems to be better to continue the biologics. In that case, it is recommended to try to discontinue concomitant corticosteroids or NSAIDs first, and then to reduce the dose of biologics, and finally to start considering the discontinuation of biologics.