Treat-to-target strategies in the management of patients with rheumatoid arthritis (RA) involve intensifying medication as long as low disease activity or remission is not achieved. Our aim was to discuss reasons and opportunities for tapering and discontinuing medication when the target is achieved, in particular of biological agents.
Data from the Behandel Strategieen (BeSt) study are presented a multicentre randomised clinical trial comparing 4 treatment strategies in patients wit recent onset active RA (1987 criteria): 1. Sequential monotherapy, 2. Step up to combination therapy (both starting with methotrexate (MTX) monotherapy), 3. initial combination therapy with MTX sulfasalazine and predenisone and 4. Initial combination therapy with MTX and infliximab. Treatment adjustments involving dose increases, drug changes or expansion to combination therapy occurred based on three-monthly calculations of the Disease Activity Score (DAS), with a target of s2.4. If this was achieved for 2 consecutive evaluations, treatment was tapered (combinations to monotherapy, monotherapy to maintenance dose). Predenisone and infliximab (euther as part of initial treatment or as delayed treatment after failure on earlier therapies in arms 1, 2 and -for infliximab- 3) were always tapered and discontinued before other druges. The outcomes of discontinuation of infliximab are presented.
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