TY - JOUR
T1 - Tapering of TNF inhibitors in axial spondyloarthritis in routine care-2-year clinical and MRI outcomes and predictors of successful tapering
AU - Wetterslev, Marie
AU - Georgiadis, Stylianos
AU - Sorensen, Inge Juul
AU - Pedersen, Susanne Juhl
AU - Christiansen, Sara Nysom
AU - Hetland, Merete Lund
AU - Brahe, Cecilie Heegaard
AU - Bakkegaard, Mads
AU - Duer, Anne
AU - Boesen, Mikael
AU - Gosvig, Kasper Kjaerulf
AU - Moller, Jakob Mollenbach
AU - Krogh, Niels Steen
AU - Jensen, Bente
AU - Madsen, Ole Rintek
AU - Christensen, Jan
AU - Hansen, Annette
AU - Norregaard, Jesper
AU - Rogind, Henrik
AU - Ostergaard, Mikkel
PY - 2022/5/30
Y1 - 2022/5/30
N2 - Objectives In a 2-year follow-up study of patients with axial spondyloarthritis (axSpA) in clinical remission who tapered TNF inhibitor (TNFi) treatment according to a clinical guideline, we aimed to investigate the proportion who successfully tapered/discontinued therapy and baseline predictors thereof. The proportion regaining clinical remission after flare and the progression on MRI/radiography were also assessed. Methods One-hundred-and-nine patients (78 [72%]/31 [28%] receiving standard and reduced dose, respectively) in clinical remission (BASDAI < 40, physician global score < 40) and no signs of disease activity the previous year tapered TNFi as follows: to two-thirds of standard dose at baseline, half at week 16, one-third at week 32 and discontinuation at week 48. Patients experiencing clinical, BASDAI or MRI flare (predefined criteria) stopped tapering and escalated to previous dose. Prediction analyses were performed by multivariable regression. Results One hundred and six patients (97%) completed 2 years' follow-up; 55 patients (52%) had successfully tapered: 23 (22%) receiving two-thirds, 15 (14%) half, 16 (15%) one-third dose and 1 (1%) discontinued. In patients at standard dose at baseline (n = 78), lower physician global score was the only independent predictor of successful tapering (odds ratio [OR] = 0.79 [95% CI: 0.64, 0.93]; P = 0.003). In the entire patient group lower physician global score (OR = 0.86 [0.75, 0.98]; P = 0.017), lower Spondyloarthritis Research Consortium of Canada (SPARCC) Sacroiliac Joint Erosion score (OR = 0.78 [0.57, 0.98]; P = 0.029) and current smoker (OR = 3.28 [1.15, 10.57]; P = 0.026) were independent predictors of successful tapering. At 2 years, 97% of patients were in clinical remission. Minimal changes in imaging findings were observed. Conclusion After 2 years following a clinical guideline, 52% of patients with axSpA in clinical remission had successfully tapered TNFi, only 1% discontinued. Baseline physician global score was an independent predictor of successful tapering.
AB - Objectives In a 2-year follow-up study of patients with axial spondyloarthritis (axSpA) in clinical remission who tapered TNF inhibitor (TNFi) treatment according to a clinical guideline, we aimed to investigate the proportion who successfully tapered/discontinued therapy and baseline predictors thereof. The proportion regaining clinical remission after flare and the progression on MRI/radiography were also assessed. Methods One-hundred-and-nine patients (78 [72%]/31 [28%] receiving standard and reduced dose, respectively) in clinical remission (BASDAI < 40, physician global score < 40) and no signs of disease activity the previous year tapered TNFi as follows: to two-thirds of standard dose at baseline, half at week 16, one-third at week 32 and discontinuation at week 48. Patients experiencing clinical, BASDAI or MRI flare (predefined criteria) stopped tapering and escalated to previous dose. Prediction analyses were performed by multivariable regression. Results One hundred and six patients (97%) completed 2 years' follow-up; 55 patients (52%) had successfully tapered: 23 (22%) receiving two-thirds, 15 (14%) half, 16 (15%) one-third dose and 1 (1%) discontinued. In patients at standard dose at baseline (n = 78), lower physician global score was the only independent predictor of successful tapering (odds ratio [OR] = 0.79 [95% CI: 0.64, 0.93]; P = 0.003). In the entire patient group lower physician global score (OR = 0.86 [0.75, 0.98]; P = 0.017), lower Spondyloarthritis Research Consortium of Canada (SPARCC) Sacroiliac Joint Erosion score (OR = 0.78 [0.57, 0.98]; P = 0.029) and current smoker (OR = 3.28 [1.15, 10.57]; P = 0.026) were independent predictors of successful tapering. At 2 years, 97% of patients were in clinical remission. Minimal changes in imaging findings were observed. Conclusion After 2 years following a clinical guideline, 52% of patients with axSpA in clinical remission had successfully tapered TNFi, only 1% discontinued. Baseline physician global score was an independent predictor of successful tapering.
KW - axSpA
KW - TNF inhibitors
KW - prediction
KW - successful tapering
KW - MRI
KW - RESONANCE-IMAGING INDEX
KW - ANKYLOSING-SPONDYLITIS
KW - RESEARCH CONSORTIUM
KW - DISEASE-ACTIVITY
KW - DOSE REDUCTION
KW - REMISSION
KW - VALIDATION
KW - BATH
KW - DISCONTINUATION
KW - INFLAMMATION
U2 - 10.1093/rheumatology/keab755
DO - 10.1093/rheumatology/keab755
M3 - Journal article
C2 - 34636846
VL - 61
SP - 2398
EP - 2412
JO - Rheumatology
JF - Rheumatology
SN - 1462-0324
IS - 6
ER -