{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T17:50:06Z","timestamp":1792173006081,"version":"4.4.0"},"reference-count":57,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"vor","delay-in-days":5,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["ascpt.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Translational Sci"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:label\/>\n                    <jats:p>Rheumatoid arthritis (RA) requires lifelong treatment with disease\u2010modifying antirheumatic drugs (DMARDs). In patients with sustained disease control, DMARD de\u2010escalation has been proposed to lessen treatment burden, but its efficacy and safety remain elusive. We conducted a systematic review and meta\u2010analysis of randomized controlled trials evaluating DMARD tapering or withdrawal in controlled RA. PubMed, Embase, and the Cochrane Library were searched to January 16, 2026. The primary outcome was disease flare, and secondary outcomes included radiographic progression and adverse events (AEs). Risk ratios (RRs) were pooled using Mantel\u2013Haenszel models. Prespecified subgroup analyses were conducted by DMARD class and follow\u2010up duration. In total, 27 publications comprising 5262 participants were included. Any DMARD tapering increased flare risk overall (RR 1.56, 95% CI 1.26\u20131.98), mainly driven by the biologic DMARD (bDMARD) subgroup, with increased flare risk observed &lt;\u20099\u2009months (RR 1.61, 95% CI 1.13\u20132.31), but not at longer follow\u2010up (&gt;\u20099\u2009months). In contrast, any DMARD withdrawal substantially increased flare risk (RR 2.23, 95% CI 1.83\u20132.94), primarily driven by the bDMARD subgroup across all follow\u2010up durations (&lt;\u20099\u2009months, 9\u201318\u2009months, and &gt;\u200918\u2009months). Both tapering (weak evidence) and withdrawal (strong evidence) promoted radiographic progression at 9\u201318\u2009months and &gt;\u200918\u2009months. Neither tapering nor withdrawal reduced AEs. In conclusion, DMARD tapering, particularly of bDMARDs, should be considered cautiously in controlled RA because of the increased flare risk, possible radiographic progression, without clear reduction in AEs. DMARD withdrawal should be generally avoided whenever possible.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>CRD420251066774 (PROSPERO)<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/cts.70740","type":"journal-article","created":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T11:52:58Z","timestamp":1791287578000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Temporal Patterns of Outcomes After\n                    <scp>DMARD<\/scp>\n                    Tapering or Withdrawal in Rheumatoid Arthritis With Sustained Disease Control: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1111","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-6598-2998","authenticated-orcid":false,"given":"Xiaoyan","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, West China Hospital Sichuan University  Chengdu China"},{"name":"West China School of Nursing Sichuan University  Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2135-5287","authenticated-orcid":false,"given":"Rajan Kumar","family":"Pandey","sequence":"additional","affiliation":[{"name":"Medical Inflammation Research, Department of Medical Biochemistry and Biophysics Karolinska Institute  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-0588-2948","authenticated-orcid":false,"given":"Xi","family":"Luo","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, West China Hospital Sichuan University  Chengdu China"},{"name":"West China School of Nursing Sichuan University  Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5178-3437","authenticated-orcid":false,"given":"Zhongwei","family":"Xu","sequence":"additional","affiliation":[{"name":"Medical Inflammation Research, Department of Medical Biochemistry and Biophysics Karolinska Institute  Stockholm Sweden"},{"name":"Department of Orthopedic Surgery The First Affiliated Hospital of Chongqing Medical University  Chongqing China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,6]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41584-019-0170-5"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2019.13102"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)61704-9"},{"key":"e_1_2_11_5_1","article-title":"Adverse Effects of Biologics: A Network Meta\u2010Analysis and Cochrane Overview","volume":"2","author":"Singh J. 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