Tumour-necrosis-factor alpha (TNF-α) blockers are highly effective in patients with rheumatoid arthritis, but their use is limited by the high costs of the drug: around €10,000 to € 15,000 per patient per year. In a recent randomised study, it was shown that dose reduction, or even stopping the medication, was possible in 43% and 20% of patients, respectively; the percentage of patients with a major flare was comparable: 10% versus 12%. Another study, in patients with rheumatoid arthritis in clinical remission, showed no difference in response between patients continuing etanercept 50 mg per week and patients in whom the dosage was reduced to 25 mg per week. These studies suggest that dose-reduction is possible in a substantial number of patients with rheumatoid arthritis. It is not yet possible, however, to predict which individuals are at high risk for flares when reducing the dosage of TNF-α blocking agents.
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