Christopher Edwards discusses the latest evidence and shares his opinion on tapering therapy in patients with rheumatoid arthritis.

The average daily dose of prednisolone decreased significantly during this period, from 14.21 to 10.67 mg, which the researchers say is “compatible with standard-of-care tapering.”

Study participants were randomly assigned to receive intravenous tocilizumab 8 mg/kg (n=49) or placebo (n=51) every 4 weeks for 24 weeks, combined with predefined standardized tapering of oral prednisone.

Most patients with axial spondyloarthritis who stop taking ixekizumab respond to the treatment when it is reintroduced following disease flare, analysis of COAST-Y data suggests.

A tapering treat-to-target strategy can lead to a large reduction in TNF inhibitor dose without impacting disease control in people with psoriatic arthritis or axial spondyloarthritis, study findings indicate.

Despite this “numerical trend suggesting that steroid tapering was possible to a greater extent in the ustekinumab group compared with the placebo group, there was insufficient evidence to support continuation of development of ustekinumab in patients with SLE,” and the sponsor terminated the study, say van Vollenhoven et al.

Phase 3 SAPHYR study findings suggest that the IL-6 receptor inhibitor sarilumab with glucocorticoid taper is an efficacious treatment option for patients with steroid-resistant polymyalgia rheumatica.

Findings from the GLORIA trial suggest that older patients with established rheumatoid arthritis could benefit from 2 years of low-dose glucocorticoids in addition to their existing disease-modifying treatment with a favorable balance of benefit and harm.

Corticosteroid tapering was required from week 8–20, with optional further tapering from week 32–40.

Therefore, disease activity-guided individualized stepwise tapering may become one of the feasible therapeutic strategies for AS in the future.

Findings from a proof-of-concept trial provide preliminary evidence to suggest that the JAK inhibitor baricitinib is well tolerated and may have efficacy for the treatment of relapsing giant cell arteritis.

Nonetheless, the authors conclude that using “S100A12/high-sensitivity C-reactive protein as markers of subclinical inflammation may help to evaluate the risk of flares and guide treatment decision.”

The authors also address treatment tapering and discontinuation in patients with inactive systemic JIA, as well as other aspects of JIA management, such as factors impacting treatment choice.

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How can rheumatologists respond to the challenges associated with rituximab use during the pandemic?

Click through for our Q&A on COVID-19 vaccination in patients with rheumatic diseases, including considerations for those taking rituximab  Wallace also suggests that rheumatologists should look more closely at DMARD treatment tapering in day-to-day practice, emphasizing that how to “stratify and identify those patients in whom we can try to limit some of their immunosuppression” remains an important question.

Findings from the phase 2 TitAIN trial support further investigation of the IL-17A inhibitor secukinumab for the treatment of giant cell arteritis.

Approximately half of patients with rheumatoid arthritis in sustained remission could feasibly taper or stop DMARD treatment for at least 12 months without experiencing relapse, results of the phase 3 RETRO study indicate.

They explain that background therapy in both groups comprised mycophenolate mofetil 1 g twice daily plus intravenous methylprednisolone 0.25–0.5 g/day for 2 days followed by rapidly tapering oral prednisone with a starting dose of 20–25 mg/day.