A temporary withdrawal of biological treatment following remission in people with rheumatoid arthritis (RA). Early and aggressive treatment of RA with disease-modifying anti-rheumatic drugs (DMARDs) such as methotrexate and biologicals (medications that target a specific protein made by the immune system) has allowed patients with RA to achieve remission — the complete or partial disappearance of all signs and symptoms. When remission has been sustained for six months to a year or more, some doctors consider either reducing the dose of their RA drugs or temporarily stopping them altogether. Drug holidays may be needed, for example, when the patient has an infection or undergoes surgery.
Studies on the effects of drug holidays have yielded mixed results. When the biologicals infliximab and adalimumab were discontinued and then started again, they lost their effectiveness as the patients’ bodies developed antibodies to them. In a 2012 study, discontinuing the biological abatacept for three months did not affect the long-term effect on therapy. In another study of patients who had remission with a combination of methotrexate and etanercept, continuing combination therapy at a reduced dosage resulted in better control than switching to methotrexate alone. The researchers concluded that withdrawal of biological therapy may be reasonable in some patients, particularly those with sustained remission, but doctors should closely monitor patients for signs and symptoms of disease progression, which would warrant restarting treatment with the biological.