DMARD tapering and drug cessation in adult inflammatory arthritides: a scoping review of European clinical guidelines

Résumé fourni par la source

This scoping review will map and synthesise recommendations from European clinical guidelines on the tapering, dose reduction, dose spacing, withdrawal, and cessation of disease-modifying antirheumatic drugs (DMARDs) and glucocorticoids in adults with inflammatory arthritides. It will focus on guidelines addressing rheumatoid arthritis, psoriatic arthritis, spondyloarthritis (including axial and peripheral forms), and adults with juvenile idiopathic arthritis. Modern treat-to-target care means that many adults with inflammatory arthritis now reach sustained remission or low disease activity, which makes the question of whether, when, and how to reduce or stop treatment increasingly relevant. Guidance on tapering and cessation is reflected in European and national rheumatology guidelines, but recommendations may vary in the patient groups considered eligible, the drug classes addressed, the sequence and pace of reduction, and whether complete drug cessation or drug-free remission is advised or discouraged. The terminology used also varies between guidelines, and the extent of this variation across Europe has not been comprehensively mapped. The purpose of this review is to identify how European clinical guidelines define and recommend tapering and cessation, and to chart the range, content, and consistency of these recommendations. Specific areas of interest include the clinical circumstances under which tapering may be considered, the drug classes addressed, the recommended order and approach to tapering, monitoring strategies, flare management, and the role of shared decision-making and patient preference. The review will be conducted using established scoping review methodology and reported in accordance with PRISMA-ScR guidance. The expected output is a structured map and narrative synthesis of guideline recommendations, presented in summary tables and supporting text, describing how recommendations differ across countries, diseases, and drug classes, and over time. The review aims to identify where European guidelines agree and diverge, to highlight areas of uncertainty and gaps in the underlying evidence, and to inform future research and consensus work. Findings are intended for peer-reviewed publication and dissemination through relevant rheumatology channels.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.