Tapering toward drug-free remission can be achieved in some rheumatoid arthritis patients, with generally short-lived clinical impact from flares, findings of a small study suggest.
Around two-thirds of patients with RA can achieve remission through DMARD regimens, although this entails the risk of long-term immunosuppression and requires resource-intensive drug monitoring and prescribing systems, according to the paper, published in Rheumatology Advances in Practice [link here].
Dr Kenneth Baker. Source NIHR
The study’s authors, led by Dr Kenneth Baker of the NIHR Newcastle Biomedical Research Centre and the Rheumatology Department of the Newcastle upon Tyne Hospitals NHS Foundation Trust, also noted that while many patients in sustained clinical remission choose to taper DMARDs and up to 50% achieve drug free remission (DFR), it can be challenging to predict success rates.
The team analysed data from patients enrolled in the RheumatOid Arthritis DMard tAPering (ROADMAP) service at Newcastle Hospitals between January 2023 and March 2025. Patients were eligible to enrol in the service if they had a clinical diagnosis of RA with a DAS28-CRP of less than 2.4 at enrolment and no escalation of treatment or use of steroids in the past 12 months.
The study focused in particular on examining the frequency and clinical impact of disease flares as well as the drug costs saved by implementing standardised DMARD tapering schedules.
ROADMAP patients tapered their DMARD therapy at routine three-monthly reviews. Patients could request additional visits in the event of possible flares, and confirmed flares were treated with the reintroduction of treatment from the previous tapering step, as well as corticosteroids, if clinically necessary.
Thirty-seven patients were enrolled in ROADMAP at the time of the study, with 23 maintaining remission. Ten of these were in DFR for a median follow-up range of 336 days, while six were continuing to taper and seven had decided to stop tapering short of DMARD discontinuation.
Thirteen patients (35%) met the flare definition during follow-up at a median range of 259 days from enrolment. Of these, DAS28-CRP-based disease activity was high (DAS28-CRP > 4.6) during 1 flare, moderate (>2.9-4.6) during 6 flares, low (2.4- 2.9) during 5 flares, and was classified as remission (DAS28-CRP < 2.4) in one case with swollen joints outside of DAS28 assessment.
Twelve of the thirteen patients who met the flare definition had a post-flare review by the time of analysis, with remission re-captured in all patients with a DMARD dose lower (5), equal to (6) or greater than (1) the baseline.
Only two flares spanned more than one visit interval of more than three months.
In addition to the successful tapering to drug-free remission, the study achieved total savings of £74,633.60 over 27 months, according to prices listed in the British National Formulary.
The savings were primarily realised from patients tapering a biological or targeted DMARD, which saved a median of £4,934 per patient per year, the researchers noted. Actual drug costs savings, are nonetheless likely to vary depending on local procurement arrangements, they said.
“This data presents real-world evidence from a UK cohort that tapering to drug free remission is achievable in some RA patients and where flare occurs this is relatively mild in most cases, with short-lived clinical impact,” the researchers concluded.
“Nevertheless, our observations are exploratory and further analyses in larger and more representative cohorts are required. Repeated analysis of the ROADMAP service cohort at a time of increased sample size and follow-up is planned to further validate our findings.”