Hur påverkar dosjustering ellernedtrappning av adalimumab ochetanercept behandlingsresultat hospatienter med reumatoid artrit?

Sammanfattning

Background Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by persistent joint inflammationthat can also affect organs such as the lungs, heart, and eyes. Both genetic and environmental factors,including smoking and air pollution, contribute to disease development. Common symptoms include jointpain, swelling, and stiffness, typically occurring symmetrically. Without adequate treatment, RA may leadto irreversible joint damage. Current treatment strategies aim to reduce inflammation, relieve symptoms,and prevent disease progression through medications such as nonsteroidal anti-inflammatory drugs(NSAIDs), corticosteroids, methotrexate, and tumor necrosis factor (TNF) inhibitors includingadalimumab and etanercept. Disease activity is commonly assessed using the Disease Activity Score 28(DAS28). Aim This literature review aimed to evaluate the effects of dose tapering strategies for the TNF inhibitorsadalimumab and etanercept on clinical outcomes in patients with RA. The primary focus was on diseaseactivity, sustained remission, and the risk of disease flares. Method A systematic search of PubMed was conducted to identify randomized controlled trials investigating dosereduction strategies in RA patients. Five studies met the inclusion criteria and were included in the review. Results The findings indicate that gradual and moderate dose tapering is feasible for many patients withoutsignificantly compromising disease control. Dose reductions of approximately 33% or extended dosingintervals were generally well tolerated and were not associated with a major increase in severe flares. Incontrast, more intensive tapering strategies, such as 66% dose reduction or complete discontinuation,were consistently linked to higher relapse rates. Although many patients were able to reduce or stoptreatment successfully, flare rates remained considerable, particularly with aggressive taperingapproaches. Discussion The evidence suggests that individualized treatment strategies, including therapeutic drug monitoring,may help optimize therapy by reducing drug exposure while maintaining clinical efficacy. However, somepatients who experienced flares did not fully regain previous disease control after restarting treatment,highlighting the importance of careful patient selection and close monitoring. Overall, gradual tapering ofadalimumab and etanercept appears to be a viable option for patients in stable remission, whereascomplete withdrawal carries a substantial risk of relapse and should be approached cautiously