Discontinuing or Tapering Biologic or Targeted Synthetic Disease-Modifying Anti-Rheumatic Drugs in Psoriatic...

We aim to review the current state of evidence about tapering or withdrawal of biological (b-) or targeted synthetic (ts-) disease-modifying anti-rheumatic drugs (DMARDs) in psoriatic arthritis (PsA).

We search the literature for published articles in withdrawal or tapering of b-/ts-DMARDs in PsA. We summarized data according to remission criteria prior to therapy tapering, relapse criteria, relapse rate and re-treatment effects. We collected data on the effect of tapering on safety, quality of life, costs, and predictors for successful tapering.

A total of 11 observational studies and 4 randomized controlled trials (RCT) in tapering or withdrawal of b-DMARDs were included. Most data were derived from observational studies; high quality of evidence from RCTs remained sparse. b-DMARDs withdrawal generally led to high rates of flare, whilst gradual tapering of therapy while maintaining a low disease activity state may be feasible, and safe. There were high rates of response with re-treatment with b-DMARDs regimens during flares. Heterogeneity in remission criteria prior to therapy tapering regimens and relapse criteria was noted. Lower disease activity prior to tapering seems to predict success more consistently; other predictive variables were inconsistent. Predictive biomarkers for successful therapy tapering were lacking.

Tapering of biologic therapy in PsA patients may be effective and safe in low disease activity states. Lack of standardization of tapering strategies warrants further studies. The knowledge gap lies in the lack of data from high-quality RCTs and biomarkers that predict success in tapering therapy for patients with PsA.