Efficacy of tapering biologics and JAK inhibitors in rheumatoid arthritis: A systematic review and meta-analysis

Abstract

Objective

This study assessed the evidence on the efficacy of tapering anti-TNF, JAK inhibitors, and tocilizumab in patients with rheumatoid arthritis (RA).

Methods

In February 2024, a systematic review was conducted by searching Medline, Embase, Web of Sciences, and the Cochrane Library for randomized controlled trials comparing the efficacy of tapering vs standard treatment. The outcomes evaluated were the maintenance of low disease activity (LDA), remission, and flare-ups. A meta-analysis was conducted when data were available. The risk of bias was assessed using RoB 2. The study was registered on PROSPERO and conducted in accordance with the PRISMA guidelines.

Results

A total of 2861 records were identified, with 1638 records screened after removing duplicates. Finally, fifteen studies involving 2782 patients were included. Follow-up ranged from 6 months to 3.5 years. Tapering anti-TNF did not affect LDA maintenance while showing a lower probability of maintaining remission (RR 0.69, 95% CI 0.57–0.84) and a higher risk of flare-ups (RR 1.96, 95% CI 1.57–2.45). Tapering JAK inhibitors showed a decreased probability of maintaining LDA (RR 0.83, 95% CI 0.76–0.91) and remission (RR 0.86, 95% CI 0.75–0.99), and more frequent and earlier flares. Tapering tocilizumab also resulted in a lower probability of maintaining LDA or remission and a higher risk of flares. Several included studies presented a risk of bias, mainly related to outcome measurement and open-label designs.

Conclusion

Although tapering anti-TNF did not affect LDA maintenance, due to the increased risk of flare-ups and reduced remission probability, routine dose tapering of anti-TNF, JAK inhibitors, and tocilizumab for patients with RA is not recommended in all of them. Identifying patients who may benefit from tapering is crucial.