5
Tapering/Discontinuing Therapy
➤ For patients who achieve the goals of therapy (for example, ideally
remission, or low disease activity if remission is not achievable),
tapering and ultimately discontinuing therapy may be considered.
➤ Potential benefits of tapering may include lesser risks of adverse
effects as well as pharmacoeconomic benefits.
➤ The decision to taper therapy should be with the patients' thorough
understanding and direct involvement.
➤ Discussions between patient and clinician should inform the optimal
approach to tapering for each individual (for example, decreasing
dosages, increasing treatment intervals, appropriate time intervals
for making changes).
➤ Patients and clinicians need to understand that the potential
drawbacks of tapering include:
• Reactivation of disease activity, with the possibility that re-achievement of the
target may not be immediate and may not always be achieved
• At present it is not possible to predict a priori which patients might be able to
successfully taper, which patients may be able to come off all medications, and
which patients will not be able to taper at all
• Although focused on active domains such as peripheral arthritis, it is not
known how tapering of effective therapy might influence other outcomes, such
as the increased risk of cardiovascular disease presumably related to systemic
inflammation
