From Canadian Living Guidelines to Global Living Guidelines: A Post Pandemic Effort

Since the coronavirus disease 2019 (COVID-19) pandemic, “living” practice guidelines are increasingly being used to ensure that recommendations are responsive to rapidly emerging evidence. In this issue of The Journal of Rheumatology , Hazlewood et al provide living recommendations on the issue of biologic (b-) and targeting synthetic (ts-) disease-modifying antirheumatic drug (DMARD) de-escalation in adults with rheumatoid arthritis (RA).1 The panel recommends that patients with RA in sustained remission or low disease activity for at least 6 months and ideally 12 months, upon glucocorticoid discontinuation, are offered a trial of stepwise tapering (ie, extension of interval between doses or dose reduction) but no discontinuation of bDMARD (ie, originator and biosimilars) and tsDMARD therapy. This is a conditional recommendation, meaning that “the majority of people with RA in this situation would want the suggested course of action, but many would not.”1 This recommendation is meant to be based on a shared decision including the discussion of a flare management plan and only in patients who have rapid access to rheumatology care in case of flare. If access to care is … Address correspondence to Dr. I. Colmegna, The Research Institute of the McGill University Health Centre, 1001 Decarie Blvd, Office # EM2-3238, Montreal, QC H4A 3J1, Canada. Email: ines.colmegna{at}mcgill.ca.