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JOURNAL ARTICLE
REVIEW
[Tapering and termination of immunosuppressive treatment in spondyloarthritides (including psoriatic arthritis)].
Zeitschrift Für Rheumatologie 2017 Februrary
BACKGROUND: Immunomodulatory long-term treatment has also become the standard treatment for spondyloarthritides (SpA), including psoriatic arthritis (PsA); however, uncertainty exists about dose reduction or termination of treatment after remission or low disease activity.
OBJECTIVE: When is it possible to reduce medication or terminate treatment for SpA?
MATERIAL AND METHODS: An extensive non-systematic literature search was performed focusing on practice guidelines, systematic meta-analyses and clinical trials on medicinal long-term treatment and voluntary medication reduction in axial and peripheral SpA, including PsA.
RESULTS: The chances of drug-free remission after treatment with biologics for axial SpA and in PsA are low; however, in remission or a state of low disease activity reduction of the cumulative dosage of biologics can be successful in 53-100% of cases without a significant increase in disease activity. The current state and duration of remission, with or without comedication with nonsteroidal anti-inflammatory drugs (NSAID), extra-articular disease manifestations and the results of previous treatment attempts have to be carefully taken into consideration before elective dose reduction.
CONCLUSION: Reduction of long-term treatment is an individualized decision made jointly by patients and physicians. The risk of flares and especially of extra-articular disease manifestations needs to be weighed against the possible advantages of reduced medication. Maintainenance of mediction-free disease remission is too rare in SpA or PsA patients carefully selected for biologics treatment, to allow a later voluntary termination of therapy, without at least a prior cautious attempt at dose reduction.
OBJECTIVE: When is it possible to reduce medication or terminate treatment for SpA?
MATERIAL AND METHODS: An extensive non-systematic literature search was performed focusing on practice guidelines, systematic meta-analyses and clinical trials on medicinal long-term treatment and voluntary medication reduction in axial and peripheral SpA, including PsA.
RESULTS: The chances of drug-free remission after treatment with biologics for axial SpA and in PsA are low; however, in remission or a state of low disease activity reduction of the cumulative dosage of biologics can be successful in 53-100% of cases without a significant increase in disease activity. The current state and duration of remission, with or without comedication with nonsteroidal anti-inflammatory drugs (NSAID), extra-articular disease manifestations and the results of previous treatment attempts have to be carefully taken into consideration before elective dose reduction.
CONCLUSION: Reduction of long-term treatment is an individualized decision made jointly by patients and physicians. The risk of flares and especially of extra-articular disease manifestations needs to be weighed against the possible advantages of reduced medication. Maintainenance of mediction-free disease remission is too rare in SpA or PsA patients carefully selected for biologics treatment, to allow a later voluntary termination of therapy, without at least a prior cautious attempt at dose reduction.
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