Outcomes of Tapering Biologic and Targeted Synthetic DMARDs in Rheumatoid Arthritis: A Multicentre Randomised Non‐Inferiority Trial
Arthritis & Rheumatology · 6 Oct 2026
† Impact is the editorial-priority score. All scores are out of 100. Clinical is a stored clinical-importance score from the earlier method; it has not been recalculated.
Why it matters
Patients with RA on biologics or JAK inhibitors often come to orthopaedic surgery, and knowing that carefully supervised dose reduction usually preserves disease control helps in perioperative medication discussions and co-management with rheumatology.
The evidence
This Korean trial randomised 348 adults with rheumatoid arthritis, who had held low disease activity for at least 6 months on a biologic or JAK inhibitor, to either stepwise dose tapering or continuing full dose. At 24 weeks, low disease activity (DAS28-ESR 3.2 or below) was maintained in 88.2% of tapered patients versus 89.6% of those who continued, a risk difference of -1.43 percentage points (95% CI -8.09 to 5.23). This met the prespecified -10% non-inferiority margin, although some disease activity scores were worse with tapering, and JAK inhibitor tapering looked less successful in exploratory analyses.
Maintenance of DAS28-ESR low disease activity at week 24: Risk difference -1.43 (95% CI -8.09 to 5.23; DAS28-ESR). The interval excludes inferiority beyond the reported margin. Relative to the reported margin of -10; margin justification and the trial's analysis assumptions still require appraisal.
Why this rigour score?
Multicentre RCTDesign starting point: 63.4
Raised the score
- Concealed allocation+5.1
- Prospectively registered+5.1
Lowered the score
- Underpowered−8.5
Methods at a glance
Recorded assessment- Outcome assessors blindedNot reported
- Allocation concealedMet
- Random sequence generatedMet
- Intention-to-treat analysisNot reported
- Adequate statistical powerUnderpowered
- Prospective registrationMet
Not reported does not mean not done. Checks have different weights; this is not a count of boxes ticked.
See the full score breakdown
- Study design starting point
- 63.4
- Concealed allocation
- +5.1
- Random sequence generation
- +2.5
- Compared against current standard of care
- +3.4
- 2% loss to follow-up
- +1.2
- Underpowered
- −8.5
- Prospectively registered
- +5.1
- Reverse fragility index 9
- +3.4
- Final rigour score rounded
- 76 / 100
Study design sets the starting point and a ceiling of 100. Recorded methods then adjust the score. Points are shown to one decimal place; the final score uses unrounded values.
Checklist from the stored appraisal. “Not met” describes the recorded criterion; it does not always produce a deduction. This overview supports reading the full study.
For journal club
1.Which RA patients (for example by drug class, csDMARD co-therapy, or remission depth) would you consider good candidates for tapering a biologic or JAK inhibitor, and which would you keep at full dose?
2.How should a patient who loses low disease activity after tapering be counseled and monitored, given that most regained control after dose re-escalation but some did not?
Original publication title
Outcomes of Tapering Biologic and Targeted Synthetic DMARDs in Rheumatoid Arthritis: A Multicenter Randomized Non‐Inferiority Trial