Division of Rheumatology, Hospital for Special Surgery, New York, USA.
Department of Medicine, Weill Cornell Medical College, New York, USA.
Curr Rheumatol Rev. 2024;20(1):46-56. doi: 10.2174/1573397119666230828160108.
Up to 30% of patients with RA are being treated with biologic (b)-disease modifying anti-rheumatic drugs (DMARDs) as monotherapy. Monotherapy with Interleukin (IL)-6 inhibitors(i) and Janus-kinase (JAK)-i has been shown to be effective. Whether patients can taper targeted therapy (bDMARDs and JAK-i) used as monotherapy (targeted monotherapy) is unknown.
To determine the feasibility of tapering of targeted monotherapy in patients with controlled RA.
We conducted a literature search in Medline, Embase and Cochrane Library for prospective studies reporting remission outcomes after tapering targeted monotherapy in RA patients, from 1/2014 - 8 /2021.
5 randomized studies which met our inclusion criteria, evaluating tapering of monotherapy with tumor necrosis factor-inhibitors, tocilizumab, abatacept and baricitinib in RA. Studies were heterogeneous. Three trials studied early RA. Three studies gradually tapered therapy, including 1 dose reduction study. Three studies tapered both biological and conventional-synthetic (cs)-DMARDs. No study compared stopping targeted monotherapy to continuing it. Remission rates were low 14-28% across all studies that stopped targeted monotherapy. The highest remission rate of 72% was reported by the dose reduction study. Trials that studied early RA reported remission rates after tapering ranging 27-72%. Trials tapering therapy in established RA reported rates of remission from 14-20%.
There is a crucial gap in published literature to inform on tapering targeted monotherapy in patients with RA. Stopping targeted monotherapy is unlikely to maintain disease control in RA. Dose reduction strategies and early treatment of disease may be associated with more successful tapering, and warrant future study.
多达 30%的类风湿关节炎（RA）患者接受生物制剂（b）-疾病修饰抗风湿药物（DMARDs）单药治疗。已证实白细胞介素（IL）-6 抑制剂（i）和 Janus 激酶（JAK）-i 的单药治疗有效。尚不清楚是否可以逐渐减少作为单药治疗（靶向单药治疗）使用的靶向治疗（bDMARDs 和 JAK-i）。
确定在控制良好的 RA 患者中逐渐减少靶向单药治疗的可行性。
我们在 Medline、Embase 和 Cochrane 图书馆中进行了文献检索，以查找从 2014 年 1 月至 2021 年 8 月期间报告 RA 患者逐渐减少靶向单药治疗后缓解结果的前瞻性研究。
5 项符合纳入标准的随机研究评估了 RA 患者中逐渐减少肿瘤坏死因子抑制剂、托珠单抗、阿巴西普和巴瑞替尼单药治疗的效果。这些研究存在异质性。三项试验研究了早期 RA。三项研究逐渐减少了治疗，包括一项剂量减少研究。三项研究均减少了生物制剂和传统合成（cs）-DMARDs 的剂量。没有研究比较停止靶向单药治疗与继续治疗。所有停止靶向单药治疗的研究缓解率均较低（14%-28%）。剂量减少研究报告的缓解率最高为 72%。研究早期 RA 的试验报告的缓解率为 27%-72%。研究在已确诊的 RA 中逐渐减少治疗的试验报告的缓解率为 14%-20%。
在已发表的文献中，有一个关键的空白领域，需要提供有关 RA 患者逐渐减少靶向单药治疗的信息。停止靶向单药治疗不太可能维持 RA 的疾病控制。减少剂量的策略和早期治疗疾病可能与更成功的减少剂量相关，值得进一步研究。
