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Withdrawal of DMARDs in patients with Rheumatoid Arthritis: a systematic review and meta-analysis.
  1. Rachel O'Mahony (rachel.o'mahony{at}rcplondon.ac.uk)
  1. National Collaborating Centre for Chronic Conditions, Royal College of Physicians, United Kingdom
    1. Alison Richards
    1. National Collaborating Centre for Chronic Conditions, Royal College of Physicians, United Kingdom
      1. Chris Deighton
      1. Department of Rheumatology, Derbyshire Royal Infirmary, United Kingdom
        1. David Scott
        1. Academic and Rheumatology Department, King’s College London, United Kingdom

          Abstract

          Objective: To define the effects of withdrawing DMARD treatment from patients with established RA receiving stable, effective long-term DMARD treatment.

          Methods: A systematic literature search was conducted. Studies were included that were of high quality and enrolled adults with RA over 2 years duration. A meta-analysis was performed on the number of disease flares in groups withdrawn from DMARD treatment compared to those who continued to receive DMARDs.

          Results: The RCT data were pooled into a meta-analysis and this showed that patients who withdrew from DMARDs had a significantly worse risk of disease flare or deterioration than those who continued DMARD treatment.

          Conclusion: We recommend that in patients who have their disease adequately controlled by DMARDs and wish to reduce the dose or withdraw them, this should be done cautiously. Their disease activity should be monitored carefully so that they recommence DMARD therapy in the event of disease flare or deterioration.

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