Dose reduction and discontinuation of non-tumor necrosis factor (TNF) biologic and targeted synthetic disease-modifying antirheumatic drugs (DMARDs) for people with rheumatoid arthritis in remission or low disease activity

Bottom Line

This Cochrane protocol outlines a planned systematic review addressing the critical clinical question of whether non-TNF biologic and targeted synthetic DMARDs can be safely reduced or discontinued in rheumatoid arthritis patients achieving remission or low disease activity. While the protocol demonstrates methodological rigor expected from Cochrane reviews, no evidence synthesis has been completed yet. The research question is highly clinically relevant, particularly given the high cost of these medications and potential for long-term adverse effects. Australian rheumatologists managing patients on PBS-subsidised biologics would benefit significantly from this evidence, as current guidelines provide limited guidance on dose reduction strategies. The review, when completed, could inform evidence-based approaches to biologic stewardship and potentially reduce healthcare costs while maintaining disease control. However, clinicians must await the completed review before making practice changes.