Dosing down with biologic therapies: a systematic review and clinicians' perspective

Area of Science:

• Rheumatology
• Pharmacology

Background:

• Biologic therapies have improved remission rates in rheumatic diseases.
• Uncertainty exists regarding optimal strategies after achieving remission or low disease activity.

Purpose of the Study:

• To systematically review the literature on the effectiveness of reducing biologic dosing in rheumatic diseases.
• To evaluate outcomes associated with discontinuing or reducing biologic therapy.

Main Methods:

• A broad systematic literature review was conducted.
• Fifty-two papers across various rheumatic diseases were included after screening and data extraction.

Main Results:

• Discontinuing biologic therapy frequently results in relapse, with varying rates across conditions like rheumatoid arthritis (RA), axial spondyloarthritis, and psoriatic arthritis (PsA).
• Retreatment with biologics can often re-establish acceptable disease control.
• Relapse rates after discontinuation range significantly, e.g., 48-54% in early RA and 11-53% in axial spondyloarthritis.

Conclusions:

• Sustaining remission after biologic discontinuation is challenging, with high relapse rates observed.
• Retreatment strategies appear effective in regaining disease control, but long-term efficacy, safety, and cost implications require further investigation.