Structured tapering of biologics in stable rheumatoid arthritis kept disease control as well as full dosing over 24 weeks

The edition in brief

Today's rheumatology edition leads on tapering advanced therapy. An Arthritis & Rheumatology multicentre randomised open-label trial of 348 people with rheumatoid arthritis in sustained low disease activity on biologic or targeted synthetic DMARDs found stepwise tapering non-inferior to continuation at 24 weeks: low disease activity was maintained in 88.2% versus 89.6% (difference −1.43%, 95% CI −8.09 to 5.23; margin −10%). Most who flared regained control after re-escalation, though some activity scores favoured continuation. Two NEJM phase 3 trials (779 patients) found monthly ianalumab reduced Sjögren's disease activity by about 1 point more than placebo on ESSDAI at 48 weeks, with no difference in response rates or patient-reported symptoms. A Lancet Rheumatology cohort found patients referred through an early arthritis recognition clinic had lower disease activity, less disability and twice the rate of sustained drug-free remission over five years than conventionally referred patients. An observational lupus cohort found rituximab and belimumab achieved low disease activity at similar rates. The pearl covers hydroxychloroquine dosing and retinal screening.