(Vienna, 14.10.2026) Biologicals have fundamentally transformed the treatment of rheumatoid arthritis (RA) and enable many patients to achieve sustained remission. However, one important question remains: can these medicines be safely discontinued once remission has been achieved? A research team led by the Medical University of Vienna has now investigated whether ultrasound can help identify those patients who are at increased risk of a relapse following the discontinuation of biologic therapy. Although the study, published in "RMD Open", was limited by the small number of participants and therefore did not meet its primary endpoint, the results suggest that residual inflammation detectable by ultrasound could help inform treatment decisions in the future.
As part of the prospective, multicentre study, patients with rheumatoid arthritis (RA) in sustained ACR/EULAR remission were monitored for a period of one year following the discontinuation of their biological disease-modifying antirheumatic drug (bDMARD). The research team from the Medical Universities of Vienna and Graz, as well as Bruneck Hospital in Italy, carried out regular clinical examinations and detailed ultrasound scans to detect any signs of disease relapse.
"Many patients wish to reduce or discontinue their biologic therapy once their condition is well under control. At present, however, doctors have few reliable tools at their disposal to assess for whom this is safely possible," explains study leader and corresponding author Peter Mandl (Division of Rheumatology, Department of Medicine III, MedUni Vienna). "Using ultrasound, we can detect residual inflammation in the joints, which cannot always be identified during a routine clinical examination."
Residual inflammation could indicate a subsequent relapse
The study results in detail: Patients with detectable Power Doppler signals on ultrasound at the start of the study, however, showed numerically higher relapse rates following the discontinuation of biologic therapy than patients without detectable inflammation. Furthermore, the inflammation levels recorded by ultrasound at the time of a relapse were higher than in earlier examinations during remission.
As only a third of the originally planned participants could be included in the study, no statistical significance could be demonstrated. However, as more and more patients are achieving sustained remission with modern therapies, optimising long-term treatment is becoming increasingly important. Larger studies are required to confirm these findings. However, the present study contributes to the growing body of evidence that imaging biomarkers could, in future, help to tailor decisions regarding dose reduction or the discontinuation of biologics in rheumatoid arthritis more closely to individual patients.
Publication: RMD Open
Ultrasound based withdrawal of biologics in Rheumatoid Arthritis (RA-BioStop).Christian Dejaco, Irina Gessl, Rusmir Husic, Gregor Mitter, Thomas Deimel, Angelika Lackner, Gabriela Supp, Josef Hermann, Josef Smolen, Martin H. Stradner, Daniel Aletaha, Gerold Schwantzer und Peter Mandl.
https://doi.org/10.1136/rmdopen-2026-007003