Rheumatology Unit, Queen Elizabeth Hospital, Adelaide, South Australia, Australia.
Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Melbourne, Victoria, Australia.
Intern Med J. 2022 Oct;52(10):1799-1805. doi: 10.1111/imj.15816.
Biological and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARD) have been an important advance in the management of inflammatory arthritis, but are expensive medications, carry a risk of infection and other adverse effects, and are often perceived as a burden by patients. We used GRADE methodology to develop recommendations for dose reduction and discontinuation of b/tsDMARD in people with rheumatoid arthritis (RA), axial spondyloarthritis (AxSpA) and psoriatic arthritis (PsA) who have achieved a low disease activity state or remission. The recommendations form part of the Australian Living Guideline for the Pharmacological Management of Inflammatory Arthritis, an NHMRC-endorsed 'living' guideline, in which recommendations are updated in near real-time as new evidence emerges. Conditional recommendations were made in favour of dose reduction in RA and AxSpA but not in PsA. Abrupt discontinuation of b/tsDMARD is not recommended in any of the three diseases.
生物制剂和靶向合成的疾病修饰抗风湿药物（b/tsDMARD）在治疗炎症性关节炎方面取得了重要进展，但这些药物价格昂贵，存在感染和其他不良反应风险，并且常常被患者视为负担。我们使用 GRADE 方法制定了针对已达到低疾病活动度或缓解的类风湿关节炎（RA）、中轴型脊柱关节炎（AxSpA）和银屑病关节炎（PsA）患者减少 b/tsDMARD 剂量和停药的建议。这些建议是澳大利亚炎症性关节炎药物治疗管理临床实践指南的一部分，该指南得到了 NHMRC 的认可，属于“实时更新”的临床实践指南，会随着新证据的出现及时更新推荐意见。我们做出了有条件推荐，支持在 RA 和 AxSpA 中减少剂量，但不支持在 PsA 中减少剂量。不建议在这三种疾病中突然停止使用 b/tsDMARD。
