DRESS Trial Shows TNFi Dose Reduction is Possible - Without Major Flares Save

Can TNF inhibitor therapy be withdrawn in RA patients who are in remission?  The DRESS trial reports the results of randomized trial of 180 RA patients taking either etanercept or adalimumab. Patients were randomly assigned to either usual care (no dose reduction) or a stepwise increase the injection intervals every three months, until the patients flares has a flare of disease activity or discontinuation.

In those in the reduction group, 20%  reduced the dose, 43% increased the dosing interval and 37% were unable to reduce their dose. The reduction group did have more short-lived flares and possibly more X-ray change.  Hence, disease activity guided, dose reduction strategy of adalimumab or etanercept to was not inferior to usual care with regard to major flaring, while resulting in the successful dose reduction or stopping in two thirds of patients.