skip to main content

Biologic vs DMARD Tapering Order — SCE Rheumatology MCQ

Instant feedback + full explanation. One question, done properly.

ModerateRheumatoid ArthritisBiologic vs DMARD Tapering OrderSCE Rheumatology

A 48-year-old woman with RA achieves remission (DAS28 <2.6) on Methotrexate and Etanercept. According to EULAR 2022 should Methotrexate or the biologic be tapered first?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Taper the biologic first while maintaining Methotrexate as the anchor DMARD

EULAR 2022 recommends that in sustained remission (≥6 months) the biologic should be tapered first (by extending dosing intervals or reducing dose) while maintaining Methotrexate. Methotrexate is the anchor DMARD and provides ongoing disease control and reduces the risk of relapse during biologic tapering. If remission is maintained after biologic withdrawal cautious Methotrexate tapering can then be considered. Complete withdrawal of all DMARDs is associated with high relapse rates and is generally not recommended. Biologic tapering is more successful than abrupt cessation.

Reference: EULAR 2022 RA recommendations; Smolen JS et al 2014 biologic tapering evidence