Long-Term Study Supports Disease Activity–Guided TNF Inhibitor Dose Optimization in RA

A decade-long observational study published in Rheumatology confirms that disease activity-guided dose optimization of tumor necrosis factor (TNF) inhibitors in rheumatoid arthritis (RA) is both safe and effective, allowing for significant dose reductions without compromising disease control.

The study followed 170 patients, with 127 completing the 10-year assessment. Disease activity remained consistently low, with a mean DAS28-CRP of 2.13. Over the study period, b/tsDMARD use declined from 97% at baseline to 56% at year 10.

“Long-term disease activity-guided dose optimization of TNF inhibitors in RA, including discontinuation and multiple tapering attempts, remains safe and effective,” the authors concluded. 

Among 161 patients who attempted dose optimization, 74% successfully discontinued treatment at some point, with a median duration of 7 months. Notably, 21% of patients never required treatment reinitiation. The mean dose reduction was 48% after the first optimization attempt and 33% for subsequent attempts. 

Radiographic progression, observed in 48% of patients with repeat dose reductions, was associated with disease activity rather than b/tsDMARD use, reinforcing the importance of ongoing monitoring. “Progression was associated with disease activity, not b/tsDMARD use,” the study reported. 

These findings suggest that in appropriately selected patients with RA, dose tapering and even discontinuation of TNF inhibitors can be a viable long-term strategy, provided that disease activity is closely monitored to prevent progression.

Reference
van der Togt CJT, den Broeder N, Boonstra MS, van der Maas A, den Broeder AA, van Herwaarden N. Disease activity-guided dose optimization including discontinuation of TNF inhibitors in rheumatoid arthritis is effective for up to 10 years: an observational follow-up of the DRESS study. Rheumatology (Oxford). 2025;64(2):533-540. doi:10.1093/rheumatology/keae103