Can biologic therapies be withdrawn or tapered in psoriatic arthritis?

There is a paucity of data on tapering and withdrawing therapy in psoriatic arthritis but advances in treatment and outcome measures suggest it is now time to be looking more closely at this. Several highly effective therapies are available providing the opportunity to achieve low disease activity. However, these therapies are associated with a marked increase in direct costs and patients are exposed to potentially life threatening adverse events. In addition to effective therapies the science of outcome assessment means that there are now suitable validated criteria for low disease activity which will allow both treat-to-target and a suitable measure of continuing low disease. Given these conditions, suitably designed randomized controlled trials of treatment withdrawal are now needed. Such studies will allow us to determine disease characteristics predictive of flare upon treatment withdrawal. In this way identifying which patients can successfully stop therapy will allow a more personalized approach to treatment decisions in PsA and will minimise risks and costs associated with ongoing therapy.