Dosing down with biologic therapies: a systematic review and clinicians' perspective

Rheumatology (Oxford). 2017 Nov 1;56(11):1847-1856. doi: 10.1093/rheumatology/kew464.


The effectiveness of biologic therapies now means that remission or low disease activity are realistic targets for treatment. However, after achieving remission/low disease activity, the next steps remain unclear. The aim of this publication was to conduct a broad systematic literature review to evaluate dosing down of biologics. After screening papers and abstracts for relevance and application of inclusion/exclusion criteria, a structured extraction process was used to collect information on the included studies. Fifty-two papers were included in the analysis across rheumatic disease. In patients who discontinue therapy, remission is not typically sustained, with reported rates of relapse and flare across early RA (48-54%), established RA (2-84%), axial spondyloarthritis (11-53%) and PsA (44.9%). In many cases, an acceptable disease activity can be regained upon retreatment. More research is needed to understand the long-term impacts of these strategies on efficacy, safety and cost.

Keywords: axial spondyloarthritis; biologic therapy; dose spacing; dose tapering; dosing down; psoriatic arthritis; rheumatoid arthritis; systematic review; treatment withdrawal.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Abatacept / administration & dosage
  • Adalimumab / administration & dosage
  • Antibodies, Monoclonal / administration & dosage
  • Antirheumatic Agents / administration & dosage*
  • Arthritis, Psoriatic / drug therapy*
  • Arthritis, Rheumatoid / drug therapy*
  • Biological Products / administration & dosage*
  • Certolizumab Pegol / administration & dosage
  • Etanercept / administration & dosage
  • Humans
  • Infliximab / administration & dosage
  • Maintenance Chemotherapy
  • Remission Induction
  • Rituximab / administration & dosage
  • Spondylarthropathies / drug therapy


  • Antibodies, Monoclonal
  • Antirheumatic Agents
  • Biological Products
  • Rituximab
  • Abatacept
  • golimumab
  • Infliximab
  • Adalimumab
  • Etanercept
  • Certolizumab Pegol