{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T13:55:47Z","timestamp":1791899747346,"version":"4.3.4"},"reference-count":27,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T00:00:00Z","timestamp":1791849600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T00:00:00Z","timestamp":1791849600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["acrjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthritis &amp;amp; Rheumatology"],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Evidence supporting tapering of biologic or targeted synthetic disease\u2010modifying antirheumatic drugs (b\/tsDMARDs) in patients with rheumatoid arthritis (RA) with sustained low disease activity (LDA) remains limited. We evaluated the efficacy and safety of a structured b\/tsDMARD\u2010tapering strategy in patients with RA who had achieved sustained LDA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this 24\u2010week, multicenter, randomized, open\u2010label, noninferiority trial, patients with RA receiving stable\u2010dose b\/tsDMARDs and maintaining Disease Activity Score in 28 joints using the erythrocyte sedimentation rate (DAS28\u2010ESR)\u2013defined LDA for at least six months were randomized to either stepwise dose tapering or dose continuation. The primary endpoint was maintenance of DAS28\u2010ESR LDA at week 24. The noninferiority margin was prespecified as \u221210%. Secondary endpoints included disease activity measures, remission rates, patient\u2010reported outcomes, quality of life, and adverse events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 348 patients were randomized to the continuation group (n\u00a0=\u00a0177) or tapering group (n\u00a0=\u00a0171). In the per\u2010protocol population, LDA was maintained in 89.6% and 88.2% of patients, respectively, with a risk difference of \u22121.43% (95% confidence interval \u22128.09 to 5.23), meeting the prespecified criterion for noninferiority. Similar findings were observed in the full analysis set. Most patients experiencing disease worsening regained LDA after protocol\u2010guided treatment reescalation during follow\u2010up without permanent treatment discontinuation. Most secondary outcomes were comparable between groups, although some disease activity measures favored continuation, including DAS28 using the C\u2010reactive protein level at week 12 and DAS28\u2010ESR and Simplified Disease Activity Index at week 24. Adverse events were uncommon in both groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In patients with RA with sustained LDA, structured b\/tsDMARD tapering was noninferior to treatment continuation for maintaining disease control over 24 weeks.<\/jats:p>\n                    <jats:p>\n                      <jats:boxed-text content-type=\"graphic\" position=\"anchor\">\n                        <jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" mimetype=\"image\/png\" position=\"anchor\" specific-use=\"enlarged-web-image\" xlink:href=\"graphic\/art70363-gra-0001-m.png\">\n                          <jats:alt-text>image<\/jats:alt-text>\n                        <\/jats:graphic>\n                      <\/jats:boxed-text>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/art.70363","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T06:44:37Z","timestamp":1791355477000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Outcomes of Tapering Biologic and Targeted Synthetic Disease\u2010Modifying Antirheumatic Drugs in Rheumatoid Arthritis: A Multicenter Randomized Noninferiority Trial"],"prefix":"10.1002","author":[{"given":"Dong\u2010Jin","family":"Park","sequence":"first","affiliation":[{"name":"Division of Rheumatology, Department of Internal Medicine Chonnam National University Medical School and Hospital  Gwangju Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sung\u2010Eun","family":"Choi","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Internal Medicine Chonnam National University Medical School and Hospital  Gwangju Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji\u2010Hyoun","family":"Kang","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Internal Medicine Chonnam National University Medical School and Hospital  Gwangju Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jung\u2010Yoon","family":"Choe","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Internal Medicine Daegu Catholic University School of Medicine  Daegu Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8535-0442","authenticated-orcid":false,"given":"Hye\u2010Soon","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Internal Medicine Hanyang University Guri Hospital  Guri Republic of 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