Objectives To assess the risk of losing remission, low disease activity (LDA) or radiographic progression in the case of (1) discontinuing or (2) tapering doses of biological disease-modifying antirheumatic drugs (bDMARDs) compared with continuation of the initial treatment regimen in rheumatoid arthritis (RA) patients with remission or LDA. Materials and methods A systematic literature analysis was carried out through May 2017 on the PubMed, Embase, Cochrane and international congress databases, selecting controlled trials comparing bDMARDs discontinuation/tapering versus continuation in RA patients with remission or LDA. The meta-analysis assessed the risk ratio (RR) and 95% CI of losing remission or LDA and the risk of radiographic progression after (1) discontinuing and (2) tapering doses of bDMARDs versus continuing the initial treatment. Results The meta-analysis comparing bDMARDs discontinuation versus continuation performed on nine trials showed an increased risk of losing remission (RR (95% CI)=1.97(1.43 to 2.73), P<0.0001) or LDA (RR (95% CI)=2.24(1.52 to 3.30), P<0.0001) and an increased risk of radiographic progression (RR (95% CI)=1.09(1.02 to 1.17), P=0.01) in case of bDMARD discontinuation. The meta-analysis comparing bDMARDs tapering versus continuation performed on 11 trials showed an increased risk of losing remission (RR (95% CI)=1.23(1.06 to 1.42), P=0.006) but no increased risk of losing LDA (RR (95% CI)=1.02 (0.85 to 1.23), P=0.81) nor any increased risk of radiographic progression (RR (95% CI)=1.09(0.94 to 1.26), P=0.26) in case of bDMARD tapering. Conclusion Discontinuation of bDMARDs leads to an increased risk of losing remission or LDA and radiographic progression, while tapering doses of bDMARDs does not increase the risk of relapse (LDA) or radiographic progression, even though there is an increased risk of losing remission.

中文翻译：

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在类风湿性关节炎中停用 bDMARD 或逐渐减量时，失去缓解、疾病活动度低或放射学进展的风险：文献和荟萃分析的系统分析

目的 与继续初始治疗方案相比，评估在 (1) 停止或 (2) 减量生物疾病缓解性抗风湿药物 (bDMARDs) 的情况下失去缓解、低疾病活动性 (LDA) 或影像学进展的风险在缓解或 LDA 的类风湿性关节炎 (RA) 患者中。材料和方法 对 PubMed、Embase、Cochrane 和国际大会数据库进行了截至 2017 年 5 月的系统文献分析，选择对照试验比较 bDMARDs 停药/减量与继续治疗缓解或 LDA 的 RA 患者。荟萃分析评估了 (1) 停止和 (2) 逐渐减少 bDMARD 剂量与继续初始治疗后失去缓解或 LDA 的风险比 (RR) 和 95% CI 以及影像学进展的风险。结果 在九项试验中比较 bDMARDs 停用与继续的荟萃分析显示失去缓解的风险增加（RR（95% CI）=1.97（1.43 至 2.73），P<0.0001）或 LDA（RR（95% CI）= 2.24（1.52 至 3.30），P<0.0001）和增加的放射学进展风险（RR（95% CI）=1.09（1.02 至 1.17），P=0.01）在 bDMARD 停药的情况下。在 11 项试验中比较 bDMARDs 逐渐减量与继续使用的荟萃分析显示失去缓解的风险增加（RR (95% CI)=1.23（1.06 至 1.42），P=0.006）但没有增加失去 LDA 的风险（RR (95% CI)在 bDMARD 逐渐减量的情况下，% CI)=1.02（0.85 至 1.23），P=0.81）也没有任何增加的放射学进展风险（RR（95% CI）=1.09（0.94 至 1.26），P=0.26）。