Reduction of biologics after reaching low disease activity rheumatoid arthritis has been tested in clinical trials. The aim of this systematic review is to assess the effectiveness and safety of the reduction of biologics drugs in patients with rheumatoid arthritis in low disease activity.

The protocol of this review is registered at PROSPERO (CRD42017069080). We searched MEDLINE, Embase, Scopus and The Cochrane Library for randomized controlled trials that reduced or spaced the dose of biologics in patients at low disease activity or remission state compared with maintenance. Two researchers selected studies, extracted the data, and assessed the risk of bias of the studies. Random effects meta-analyses by DerSimonian & Laird method were calculated considering intention to treat analysis to obtain the standardized mean difference (SMD) or relative risk (RR) and 95 percent confidence interval (CI). Quality of evidence will be assessed by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE).

From 725 retrieved records, seven studies were included. Compared to regular doses, reduction of biologics significantly increased the health assessment quality (SMD = 0.20; 95% CI: 0.04 0.37; I2 = 3.5%). No difference was observed for low disease activity (RR = 0.83; 95% CI: 0.68, 1.03; I2= 71.3), serious and non-serious adverse events; disease activity scores; patient global assessment and radiographic progression.

Preliminary results show no differences in clinically relevant outcomes from reduction of biologics compared to regular doses. As a limited number of studies is available, the certainty of evidence is limited and need to be monitored to better inform patients and clinicians.