Introduction: Rheumatoid arthritis (RA) is a chronic, systemic autoimmune disease, which affects joints as well as extra-articular tissues. In the last decades, increasing targeted therapeutic options dramatically improved RA management by doubling the rate of patients achieving clinical remission. Currently, there is a need for management strategies aimed at limiting treatment-related adverse events and costs in good responders.

Areas covered: Data on de-escalation of biologic drugs (especially for anti-TNF agents) are mainly available from post-hoc analyses of randomized controlled trials and from registry-based observational studies. This narrative review illustrates the rationales for dose tapering and expands to provide an overview of the efficacy of the different available strategies for reducing the exposure to biologic drugs in patients achieving a sustained clinical response. Selected studies are discussed as illustrative examples.

Expert opinion: Withdrawal of biologic therapy might be attempted in limited patients with very early RA; conversely, established RA is more suitably managed with a progressive decrease of drug regimen, by either dose reduction or injection/infusion spacing. Further studies investigating potential factors predicting post-tapering disease relapse are warranted, in order to better identify the best candidates for a decreased-dose approach.

简介：类风湿关节炎（RA）是一种慢性全身性自身免疫性疾病，会影响关节以及关节外组织。在过去的几十年中，越来越多的靶向治疗选择通过使达到临床缓解的患者比率加倍，大大改善了RA管理。当前，需要旨在限制良好反应者中与治疗有关的不良事件和费用的管理策略。

涵盖的领域：有关生物药物降级的数据（尤其是抗TNF药物）主要来自随机对照试验的事后分析和基于注册表的观察性研究。这篇叙述性评论阐明了逐渐减少剂量的原理，并进行了扩展，以概述减少可实现持续临床反应的患者对生物药物的暴露的各种可用策略的功效。选定的研究作为说明性实例进行了讨论。

专家意见：局限性RA早期患者可尝试退出生物疗法。相反，通过减少剂量或注射/输注间隔，可通过逐渐减少药物治疗来更适当地控制已建立的RA。为了更好地确定减少剂量方法的最佳候选者，有必要进行进一步研究，以研究预测渐减性疾病复发的潜在因素。