Effect of Half-Dose vs Stable-Dose Conventional Synthetic Disease-Modifying Antirheumatic Drugs on Disease Flares in Patients With Rheumatoid Arthritis in Remission: The ARCTIC REWIND Randomized Clinical Trial
RCT (n=160) found that halving the dose of conventional DMARD therapy in stable patients increased the rate of disease flares over 12 months vs continued stable dose (25% vs 6% had flares, difference 18%, 95%CI 7% to 29%) and non-inferiority was not demonstrated.
Source:
Journal of the American Medical Association
SPS commentary:
A separate study found dose adjusted infliximab (according to drug and drug antibody levels) did not increase clinical remission rates at week 30 vs conventional infliximab across a range of autoimmune inflammatory conditions (53.0% vs 50.5% respectively, p=0.78).
A related editorial comments on these studies, concluding that they provide important, clinically useful data on the treatment of diseases requiring immunomodulatory therapies. The results suggest that therapeutic drug monitoring for patients with immune-mediated inflammatory diseases, and routine DMARD dose reduction for patients with rheumatoid arthritis in remission, are not advisable for everyone. However, a subset of patients may benefit from these therapeutic approaches.