A comparison of half- (tapering) and stable-dose (non-tapering) of csDMARDs did not exhibit noninferiority for the patients with disease flares over one year, and there were considerably lesser flares in the stable-dose group, revealed a randomized clinical trial published in JAMA.

In this multicenter, parallel, open-label noninferiority study (ARCTIC REWIND), Siri Lillegraven et al. evaluated the effect of csDMARDs with tapering versus without tapering on the flares risk in 160 patients with RA in sustained remission with a follow-up of 1 year who were on constant csDMARD treatment. These patients were classified into either half-dose group or stable-dose group, with 80 patients in each group.

The Disease Activity Score (DAS) with threshold values for the remission of RA and a minimum of 2 inflamed joints from starting and after 12 months was regarded as the primary endpoint. The non inferiority margin was considered as a risk difference of 20%.

Out of total patients, 156 received the assigned therapy, of which 155 without any main protocol violations were encompassed in the primary analysis population (half-dose with 77 individuals and stable-dose with 78 individuals).

Less number of patients in the stable-dose group had disease flare compared with patients in the half-dose group (risk difference of 18%). Adverse events were witnessed in both the groups, but none led to study withdrawal (Table 1).

There was no mortality. The findings of this study did not encourage the use of half-dose csDMARDs treatment in RA patients in remission.