This Cochrane review protocol outlines a plan to evaluate whether reducing or discontinuing conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) is safe and effective for adults with rheumatoid arthritis or psoriatic arthritis who have maintained sustained remission or low disease activity. The protocol establishes a unified methodological framework for two parallel reviews, focusing on relapse risk, adverse events, and overall clinical stability following medication reduction. The authors emphasize the need to clarify whether csDMARD tapering can provide benefits—such as fewer medication-related harms or improved quality of life—without increasing disease flare rates.
The two planned reviews will separately examine csDMARD de-escalation in rheumatoid arthritis and psoriatic arthritis, considering randomized and quasi-randomized evidence to compare dose reduction strategies, complete discontinuation, and continued therapy. By synthesizing the available data, these reviews aim to determine whether csDMARD tapering is a safe and clinically reasonable approach for patients in stable remission, and where future trials are needed to guide long-term management decisions.