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Withdrawal of disease-modifying antirheumatic drugs in patients with rheumatoid arthritis: a systematic review and meta-analysis
  1. Rachel O'Mahony1,
  2. Alison Richards1,
  3. Chris Deighton2,
  4. David Scott3
  1. 1National Collaborating Centre for Chronic Conditions (NCC-CC), Royal College of Physicians, London, UK
  2. 2Department of Rheumatology, Derbyshire Royal Infirmary, Derby, UK
  3. 3Academic and Rheumatology Department, King's College London, London, UK
  1. Correspondence to Dr Rachel O'Mahony, NCC-CC, Royal College of Physicians, 11 St Andrews Place, Regent's Park, London NW1 4LE, UK; rachel.o'mahony{at}


Objective To define the effects of withdrawing disease-modifying antirheumatic drug (DMARD) treatment from patients with established rheumatoid arthritis (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 A meta-analysis was performed on the number of disease flares in groups withdrawn from DMARD treatment compared with those who continued to receive DMARD.

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

Conclusion In patients who have their disease adequately controlled by DMARD 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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  • Conflicts of interest None.

  • Provenance and peer review Not commissioned; externally peer reviewed.