How do you approach tapering decisions for disease-modifying therapy for ICI-induced inflammatory arthritis after the patient's cancer treatment has been completed or the ICI has been discontinued?

This is a great question and, honestly, one that every rheumatologist struggles with. Similar to managing other inflammatory diseases, the challenge is determining when a patient is truly in remission and whether therapy can be safely reduced or discontinued.

My approach is fairly practical:

1. The patient should be off corticosteroids first. I generally do not consider tapering a DMARD or biologic if the patient is still requiring steroids.
2. The patient should demonstrate sustained disease control off steroids. I prefer at least 2–3 months without flares or the need for rescue corticosteroids before considering a taper.
3. I assess whether the medication is still clearly providing benefit. I often ask patients whether they notice when a dose is du...