In the second installment of a slide show based on an animated discussion by members of the rheumatology journal club (#rheumjc), partipants focus on the benefits, risks, and realities of tapering biologics in clinical practice.
Part 2 of our slide show summarizing the latest conversation of the Twitter-based rheumatology journal club #rheumjc looks into tapering of biologics for rheumatoid arthritis in actual practice.Three of the participating rheumatologists practice outside the United States, offering a noteworthy difference of perspective.The discussion in Part 1 focused on a randomized trial of biologic tapering published recently in BMJ. Here, participants focused on the clinical realities: Why to taper, whom to taper, when to start tapering, how to decide whether restarting the biologic is warranted, and what happens next.
How to space the tapering of rheumatoid arthritis medications? Patients may take this matter out of your hands.
A digression about triple therapy for rheumatoid arthritis. Tapering may not be the only option. *O'Dell JR, Mikuls TR, Taylor TH et al. Therapies for active rheumatoid arthritis after methotrexate failure. N Engl J Med. 2013 Jul 25;369(4):307-18. doi: 10.1056/NEJMoa1303006. Epub 2013 Jun 11.
Next question: In what order should you taper biologics for RA patients on remission? DMARDs first? Or biologics, then DMARDs?
So you've successfully tapered biologic medication for your rheumatoid arthritis patient. Then there's a flare. What do you do?
The RA patient has flared after you tapered or discontinued a biologic medication. If you resume treatment, what are the odds it will work?
European participants in the #rheumjc discussion about tapering of biologics sense skepticism from their American peers, and attempt to dispel it.