Efficacy of withdrawal or tapering of bDMARDs vs. standard regimen in axial spondyloarthritis patients: systematic review and meta-analysis informing the update of the Spanish Society of Rheumatology Guideline
Abstract
Objectives To assess efficacy of withdrawal or tapering biologic disease-modifying antirheumatic drugs (bDMARDs) vs. maintaining a standard regimen in patients with axial spondyloarthritis (axSpA) to sustain remission. Methods We conducted a systematic review of randomized controlled trials (RCTs) through July 2025, comparing treatment discontinuation or tapering against standard bDMARDs regimens in axSpA. We included RCTs of axSpA patients randomized to treatment interruption or tapering compared with standard treatment regimens. Outcomes measures included remission or flare measured by Ankylosing Spondylitis Disease Activity Score (ASDAS), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and acute phase reactants. We rated the certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. We presented dichotomous outcomes as risk ratios (RR) with their 95% confidence intervals (CI). We used a random-effect model to perform a pooled analysis. Results Eight RCTs involving 1,384 participants were analyzed. For those in sustained remission >6 months, withdrawal led to a significantly lower rate of inactive disease state (RR 0.58, CI 0.45–0.76; high certainty) and increased risks of flare (RR 1.79, CI 1.34–2.38; high certainty) and partial flares (RR 1.57, CI 1.25–1.97; high certainty) compared to the standard regimen. Patients with short-term remission <6 months and treatment withdrawal experienced significantly…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 1,384 participants or records.
Read the paper
Related studies
- Safety and efficacy of COVID‐19 vaccines: A systematic review and meta‐analysis of controlled and randomized clinical trials
- Accuracy Comparison between Robot-Assisted Dental Implant Placement and Static/Dynamic Computer-Assisted Implant Surgery: A Systematic Review and Meta-Analysis of In Vitro Studies
- Determinants of passive antibody efficacy in SARS-CoV-2 infection: a systematic review and meta-analysis
- Cleaning efficacy of EDDY versus ultrasonically-activated irrigation in root canals: a systematic review and meta-analysis
- Bonding Efficacy of Universal Resin Adhesives to Zirconia Substrates: Systematic Review and Meta-Analysis
- In vitro antimicrobial activity of extracts and essential oils of Cinnamomum, Salvia, and Mentha spp. against foodborne pathogens: A meta-analysis study
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.