skip to main content

Biologic Dose Extension Evidence — SCE Rheumatology MCQ

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

ModerateRheumatoid ArthritisBiologic Dose Extension EvidenceSCE Rheumatology

A 55-year-old woman with RA on Adalimumab and Methotrexate is in remission (DAS28 1.8 for 12 months). Her rheumatologist considers extending the Adalimumab dosing interval from every 2 weeks to every 3 weeks as a first tapering step. What evidence supports this approach?

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

Reveal the answer and explanation

Correct answer: A — Multiple studies (STRASS DRESS POET) support biologic dose reduction/interval extension in sustained RA remission with approximately 60-80% maintaining low disease activity; retreatment is effective if flare occurs

Biologic tapering by extending dosing intervals has been evaluated in several RCTs and observational studies: STRASS (Adalimumab spacing) DRESS (dose reduction study) and POET (discontinuation trial). Approximately 60-80% of patients in sustained remission maintain low disease activity with dose reduction. If flare occurs retreatment at the original dose usually recaptures response. BSR 2019 guidelines and EULAR 2022 recommendations support considering tapering in sustained remission. Gradual dose reduction (interval extension) is preferred over abrupt cessation as it allows monitoring for early signs of flare before complete loss of disease control.

Reference: EULAR 2022 RA recommendations; Fautrel B et al 2015 STRASS trial