van Mulligen E, Weel AE, Hazes JM, et al. - This study was conducted to assess the 2-year clinical efficacy of two gradual tapering strategies. Researchers performed a multicentre single-blinded randomised controlled trial including individuals with rheumatoid arthritis (RA) with well-controlled disease for ≥ 3 consecutive months, defined as a Disease Activity Score (DAS) measured in 44 joints ≤ 2.4 and a swollen joint count ≤1, which was achieved with a conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) and a TNF-inhibitor. Individuals were assigned randomly into gradual tapering the csDMARD followed by the TNF-inhibitor, or vice versa. The primary endpoint included the number of disease flares. DMARD-free remission (DFR), DAS, functional ability (Health Assessment Questionnaire Disability Index (HAQ-DI)) and radiographic progression were considered as secondary endpoints. They randomized 189 patients to tapering their csDMARD (n=94) or TNF-inhibitor (n=95) first. It was shown that the order of tapering did not influence flare rates, DAS or HAQ-DI. The evidence revealed that DFR was achievable, slightly more frequent in patients that first tapered csDMARDs. Financial arguments may affect the decision to taper TNF-inhibitors first, because of similar effects from a clinical viewpoint.