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Pediatric Rheumatology
Published in: Pediatric Rheumatology 1/2022

Open Access 01-12-2022 | Anakinra | Review

Tapering of biological treatment in autoinflammatory diseases: a scoping review

Authors: Tatjana Welzel, Lea Oefelein, Marinka Twilt, Marc Pfister, Jasmin B. Kuemmerle-Deschner, Susanne M. Benseler

Published in: Pediatric Rheumatology | Issue 1/2022

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Abstract

Background

Biological treatment and treat-to-target approaches guide the achievement of inactive disease and clinical remission in Autoinflammatory Diseases (AID). However, there is limited evidence addressing optimal tapering strategies and/or discontinuation of biological treatment in AID. This study evaluates available evidence of tapering biological treatment and explores key factors for successful tapering.

Methods

A systematic literature search was conducted in Embase, MEDLINE, Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials using the OVID platform (1990-08/2020). Bibliographic search of relevant reviews was also performed. Studies/case series (n ≥ 5) in AID patients aged ≤ 18 years with biological treatment providing information on tapering/treatment discontinuation were included. After quality assessment aggregated data were extracted and synthesized. Tapering strategies were explored.

Results

A total of 6035 records were identified. Four papers were deemed high quality, all focused on systemic juvenile idiopathic arthritis (sJIA) (1 open-label randomized trial, 2 prospective, 1 retrospective observational study). Biological treatment included anakinra (n = 2), canakinumab (n = 1) and tocilizumab (n = 1). Strategies in anakinra tapering included alternate-day regimen. Canakinumab tapering was performed randomized for dose reduction or interval prolongation, whereas tocilizumab was tapered by interval prolongation. Key factors identified included early start of biological treatment and sustained inactive disease.

Conclusion

Tapering of biological treatment after sustained inactive disease should be considered. Guidance for optimal strategies is limited. Future studies may leverage therapeutic drug monitoring in combination with pharmacometric modelling to further enhance personalized “taper-to-target” strategies respecting individual patients and diseases aspects.
Appendix
Available only for authorised users
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Metadata
Title
Tapering of biological treatment in autoinflammatory diseases: a scoping review
Authors
Tatjana Welzel
Lea Oefelein
Marinka Twilt
Marc Pfister
Jasmin B. Kuemmerle-Deschner
Susanne M. Benseler
Publication date
01-12-2022
Publisher
BioMed Central
Published in
Pediatric Rheumatology / Issue 1/2022
Electronic ISSN: 1546-0096
DOI
https://doi.org/10.1186/s12969-022-00725-3

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