[Discontinuation of immunosuppressive and immunomodulatory drugs in connective tissue diseases].

Abstract

Remission in connective tissue diseases became a realistic goal of therapy nowadays. However, there is lack of recommendations on the management after achieving a remission. Chronic exposure to immunosuppressive or immunomodulatory drugs may be associated with adverse events, that is why temporal withdrawal or discontinuation of treatment is advisable. In patients with rheumatoid arthritis (RA) who achieve sustained remission lasting for 6-12 months, an attempt to withdraw biological disease modifying antirheumatic drugs (bDMARDs) may be considered. In most patients with established RA discontinuation of bDMARDs is accompanied by a disease flare, butthe risk of loss of good therapeutic response is lower in case of slowly tapering by expanding the interval between doses or reducing the dose of bDMARDs. Patients with early RA are more likely to have successful discontinuation of therapy. Discontinuation of conventional DMARDs (cDMARDs) is usually associated with a disease flare, that is why tapering of doses is advised rather than stopping cDMARDs. DMARDs free remission occurs relatively rare, more often in patients with seronegative RA and with early onset of modifying treatment. In lupus nephritis (LN) patients with persistent, long-term remission, progressive tapering of doses of immunosuppressive drugs and glucocorticoids is recommended, with treatment discontinuation as a goal. An attempt of treatment withdrawal may be taken in patients remaining in LN complete remission as a consequence of maintenance therapy for 3 years.The process of slow tapering of doses preceding discontinuation of drugs, may last several months. The therapy with antimalarial drugs may be helpful to maintain remission after the treatment discontinuation. There is few data on treatment discontinuation in patients with systemic lupus erythematosus (SLE) without kidney involvement. Immunosuppressive drugs withdrawal is usually performed in patients with stable serological and clinically asymptomatic disease lasting for ≥ 2 years, on maintenance antimalarial therapy. Discontinuation of immunomodulatory treatment seems unlikely in primary systemic vasculitis.

• Authors: Bożena Targońska-Stępniak
• Journal: Wiadomosci lekarskie (Warsaw, Poland : 1960) (Wiad Lek) Vol. 68 Issue 3 Pg. 265-70 ( 2015) ISSN: 0043-5147 [Print] Poland
• Vernacular Title: Odstawienie leków immunosupresyjnych i immunomodulujących w układowych chorobach tkanki łącznej.
• PMID: 26753211 (Publication Type: English Abstract, Journal Article, Review)

Chemical References

• Immunosuppressive Agents

Topics

• Connective Tissue Diseases (drug therapy)
• Drug Administration Schedule
• Humans
• Immunomodulation
• Immunosuppressive Agents (administration & dosage, adverse effects)
• Recurrence
• Remission Induction
• Withholding Treatment