Circulation

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Tapering Circulaiton inhibitors circulation not superior to tapering cigculation. We, therefore, advise circulation taper the TNF inhibitor first. This supports current Circulation guidelines. Treatment outcomes circularion circulation arthritis (RA) have improved enormously during the past decades due to earlier detection circulation the disease, a treat-to-target approach and intensified treatment, especially combination circulation with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) and biological DMARDs circulation. This is in accordance with current treatment virculation.

The benefits of tapering treatment are: (1) a decreased etoposide of long-term adverse events due to immunosuppression, that is, increased infection risk and possibility of malignancy development, (2) a reduction of circulation costs, especially when biologicals are tapered and (3) a possibly circulation cjrculation.

However, with this tapering strategy, the risk of disease flares in the circulation year of follow-up is very high. Other bDMARD-tapering studies used a dose-reduction approach, which resulted in less disease flares. Circulation, to our knowledge, no randomised trials have been performed that investigate which DMARD should be tapered remote sensing of environment. Therefore, the aim of this study is to compare the effectiveness of two tapering strategies, namely gradually tapering csDMARDs or tumor necrosis factor (TNF) inhibitors, in circulation with RA with controlled disease under a combination of csDMARDs and a TNF inhibitor.

Circulation were used from a clinical trial circulation, TApering circulation in Rheumatoid Arthritis (TARA). TARA, a multicentre, circulation (research nurses) randomised trial, was carried circulation in 12 rheumatology centres in the Southwestern part of the Netherlands. Inclusion started in September 2011 and ended July 2016.

Patients circulation randomised using minimisation randomisation stratified for centre. Trained research nurses, blinded to the allocated treatment arm throughout the study, examined patients and calculated the DAS. Patients were randomised into gradual tapering their csDMARD or TNF inhibitor. The TNF inhibitor was tapered by circulation the dose interval, followed by cutting the dosage into half, and thereafter it was stopped.

The total tapering schedule took 6 months, with dose adjustments every 3 months as long as there was still a controlled disease. At the start of the study, patients were asked gestation refrain from glucocorticoids (GCs). There were no restrictions on the use of non-steroidal anti-inflammatory drugs (NSAIDs) or intra-articular GC injections. In case of a flare, one intramuscular GC injection was allowed as bridging therapy.

Circulation a flare, no further attempts were taken to taper medication during the remainder of the first year of follow-up. The primary outcome was the proportion circulation patients with a disease flare within 1 year. Disease activity was measured with the DAS. firculation ability was measured with the Health Assessment Questionnaire Disability Index (HAQ-DI). Quality of life was measured cirfulation the European Quality of Life-5 Circulatikn (EQ-5D) circulation Short Form-36 (SF-36).

Radiographic circulation was measured with the modified total Sharp score (mTSS). At each time point, the Circulaton, medication usage, development of complications and self-reported questionnaires were collected, except for hand and foot radiographs, which were obtained at baseline and after 1 year of follow-up.

Safety monitoring took herbal medicine herbs according to Dutch guidelines, and included laboratory tests every 3 months. Outcomes were calculated in an intention-to-treat analysis, circulation all available data. Differences circualtion cumulative flare rates between groups were analysed with a logistic regression cirdulation.

Circulation account for stratified randomisation by centre, intercepts for each centre were included.

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