How do you counsel patients who prefer to continue TNFi therapy indefinitely for rheumatoid arthritis despite long-standing remission?

Do you advocate to taper the TNF-i or simply continue to monitor for long term adverse events?

This question is part of a collaboration with RheumMadness and is specifically in reference to: Tapered TNFi

Answer from: at Community Practice

I explain the risk of stopping and having a return of disease after stopping (that this could be a “drug holiday” of limited duration) and that this return of disease activity may not respond to restarting the TNF blockade therapy that had been working well for them. Then they would have...

Comments

at Uniformed Services University of the Health Sciences (USUHS)
I totally agree with Dr. @Leonard H. Sigal. For th...

Answer from: at Academic Institution

I wouldn't stop it especially if RF is still positive.

Answer from: at Community Practice

I agree with the cautious response outlined by Drs. @Sigal & @Thomas in the risk of a challenged RA flare with the withdrawal of iTNF therapy; I tend to for Boolean criteria-1 before having the discussion. I personally like to perform ultrasound on these patients, using Dr Naredo’s remissi...

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How do you counsel patients who prefer to continue TNFi therapy indefinitely for rheumatoid arthritis despite long-standing remission?

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