Biologic Tapering in RA Remission — RACP Adult Medicine MCQ

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ModerateRheumatologyBiologic Tapering in RA RemissionRACP Adult Medicine

A 55-year-old woman with RA achieves sustained remission (DAS28 <2.6) on adalimumab + methotrexate for 12 months. She asks about tapering/stopping the biologic. What is the most appropriate advice?

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Correct answer: A — Gradual biologic dose reduction/spacing with close DAS28 monitoring

Sustained remission (≥6-12 months) on biologic + csDMARD → consider gradual biologic tapering (dose reduction or interval spacing) with close monitoring (DAS28 every 1-3 months). ~50% of patients can successfully taper/stop biologics if in deep remission. If flare occurs: restart biologic at previous effective dose (most patients recapture response). csDMARD (methotrexate) should be continued during and after biologic tapering. Complete drug-free remission is achieved in a minority (~15-20%).

Reference: EULAR – 2024 – RA Tapering Recommendations; RETRO/DRESS Trials