ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 0364

Dose Tapering of TNF Inhibitors in Patients with Axial Spondyloarthritis in Routine Care – 2-year Clinical and MRI Outcomes and Predictors of Successful Tapering

Marie Wetterslev1, Stylianos Georgiadis2, Inge Juul Sørensen3, Susanne Juhl Pedersen2, Sara Nysom Christiansen4, Merete Lund Hetland1, Cecilie Heegaard Brahe2, Mads Bakkegaard5, Anne Duer6, Mikael Boesen7, Kasper Kjærulf Gosvig8, Jakob Møllenbach Møller8, Niels Steen Krogh9, Bente Jensen5, Ole Rintek Madsen5, Jan Christensen5, Annette Hansen5, Jesper Nørregaard5, Henrik Røgind5 and Mikkel Ostergaard10, 1Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark, 2Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark, 3Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark, 4Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark, 5Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark, 6Department of Radiology, Rigshospitalet, Glostrup, Copenhagen, Denmark, 7Department of Radiology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark, 8Department of Radiology, Herlev and Gentofte Hospital, Copenhagen, Denmark, 9ZiteLab ApS, Copenhagen, Denmark, Frederiksberg, Denmark, 10Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, and Department of Clinical Medicine, University of Copenhagen, Glostrup, Denmark

Meeting: ACR Convergence 2021

Keywords: , , , ,

Session Information

Date: Saturday, November 6, 2021

Title: Spondyloarthritis Including PsA – Diagnosis, Manifestations, & Outcomes Poster I: Clinical Aspects of Axial Spondyloarthritis (0357–0386)

Session Type: Poster Session A

Session Time: 8:30AM-10:30AM

Background/Purpose: In a 2-year follow-up study of patients with axial spondyloarthritis (axSpA) in clinical remission who tapered Tumor Necrosis Factor inhibitor (TNFi) treatment according to a clinical guideline, we aimed to investigate 1) the proportion who successfully tapered/discontinued therapy, 2) baseline predictors of successful tapering/discontinuation, 3) the proportion regaining clinical remission after flare and 4) the progression on magnetic resonance imaging (MRI) and radiography.

Methods: One-hundred-and-nine patients (78 (72%) on standard, 31 (28%) on reduced dose) in clinical remission with Bath ankylosing spondylitis disease activity index (BASDAI)< 40, physician global score< 40 and no signs of disease activity the previous year tapered TNFi to 2/3 of standard dose at baseline, 1/2 at week 16, 1/3 at week 32 and withdrew at week 48. Patients who experienced clinical, BASDAI or MRI flare stopped tapering and escalated to the previous dose. Prediction analyses were done by multivariable regression.

Results: Of the 106 patients who completed 2-year follow-up, 55 patients (52%) had successfully tapered (Table 1): 23 patients (22%) receiving 2/3, 15 (14%) 1/2, 16 (15%) 1/3 dose and 1 (1%) discontinued (Figure 1). In the entire patient group (all doses patients) lower physician global score (Odds ratio (OR)=0.86 (95% Confidence Interval=0.75-0.98); p=0.017), lower Spondyloarthritis Research Consortium of Canada Sacroiliac Joint Erosion score (OR=0.78 (0.57-0.98); p=0.029) and current smoking (OR=3.28 (1.15-10.57); p=0.026) were independent predictors for successful tapering. In patients at standard dose at baseline (standard dose patients) lower physician score was the only independent predictor of successful tapering (OR=0.79 (0.64-0.93); p=0.003) (Table 2). At 2 years, 97% of patients were in clinical remission. Minimal changes in imaging variables were observed.

Conclusion: Fifty-two % of patients with axSpA in clinical remission could successfully taper TNFi by following a clinical guideline and maintain remission at 2-years’ follow-up, while only 1% discontinued. Baseline physician global score was an independent predictor of successful tapering.

Values are median (IQR) unless otherwise stated. Mann Whitney U test, chi-square test or Fisher’s exact test (as appropriate) was used for analysing between-group differences; bold indicates statistically significant p-values; P<0.05 was considered statistically significant. “-“ indicates that p-value could not be calculated.

Predictors were selected by applying backward selection in stacked data. p-values by likelihood ratio tests. Bold indicates p-values<0.1 in univariate analyses. *Results were derived in all imputed datasets (missing values in selected predictors), where model estimates are pooled based on Rubin’s rules. Profile likelihood CIs were calculated according to the Pseudo-Variance modification of Rubin’s rule (PVR). AUC was estimated based on internal validation by bootstrapping with 100 samples per imputed dataset. **Results were derived in non-imputed data (no missing values in selected predictors). CIs given as profile likelihood CIs. AUC was estimated based on internal validation by bootstrapping with 1000 samples. #The bootstrap 0.632+ estimate was calculated to correct for optimism.

Disclosures: M. Wetterslev, None; S. Georgiadis, None; I. Sørensen, None; S. Juhl Pedersen, AbbVie, 1, 5, 6, Novartis, 1, 5, 6, MSD, 5, 6, Pfizer, 6, UCB, 6; S. Christiansen, Novartis, 5, BMS, 6, GE, 6; M. Lund Hetland, Bristol-Myers Squibb, 5, AbbVie, 5, Roche, 5, 12, Novartis, 5, MSD, 5, 12, Biogen, 5, 12, Elly Lilly, 12, Orion Pharma, 12, CellTrion, 12, Samsung Bioepis, 12, Janssen Biologics BV, 12, Pfizer, 5, 12; C. Heegaard Brahe, None; M. Bakkegaard, None; A. Duer, None; M. Boesen, Image Analysis Group, 2, 5, 6, Esaote, 2, 5, 6, AbbVie, 2, 5, 6, Celgene, 2, 5, 6, Eli-Lilly, 2, 5, 6, Janssen, 2, 5, 6, Novartis, 2, 5, 6, Pfizer, 2, 5, 6, UCB, 2, 5, 6, Novo, 2, 5, 6, GSK, 2, 5, 6, Takeda, 2, 5, 6, Geurbet, 2, 5, 6, Biogen, 2, 5, 6, Radiobotics, 2, 5, 6, Chondrometrics, 2, 5, 6; K. Kjærulf Gosvig, None; J. Møllenbach Møller, None; N. Krogh, None; B. Jensen, None; O. Rintek Madsen, None; J. Christensen, None; A. Hansen, None; J. Nørregaard, None; H. Røgind, None; M. Ostergaard, AbbVie, 2, 5, 6, Bristol-Myers Squibb, 2, 6, Celgene, 2, 6, Novartis, 2, 5, 6, Boehringer Ingelheim, 2, 6, Eli Lilly, 2, 6, Hospira, 2, 6, Janssen, 2, 6, Merck, 2, 5, 6, Novo, 2, 6, Orion, 2, 6, Pfizer Inc, 2, 6, Regeneron, 2, 6, Roche, 2, 6, UCB, 2, 6, GSK, 2, 6, Mundipharma, 2, 6, Schering-Plough, 2, 6, Takeda, 2, 6, Wyeth, 2, 6, Centocor, 2, 5, 6.

To cite this abstract in AMA style:

Wetterslev M, Georgiadis S, Sørensen I, Juhl Pedersen S, Christiansen S, Lund Hetland M, Heegaard Brahe C, Bakkegaard M, Duer A, Boesen M, Kjærulf Gosvig K, Møllenbach Møller J, Krogh N, Jensen B, Rintek Madsen O, Christensen J, Hansen A, Nørregaard J, Røgind H, Ostergaard M. Dose Tapering of TNF Inhibitors in Patients with Axial Spondyloarthritis in Routine Care – 2-year Clinical and MRI Outcomes and Predictors of Successful Tapering [abstract]. Arthritis Rheumatol. 2021; 73 (suppl 9). https://acrabstracts.org/abstract/dose-tapering-of-tnf-inhibitors-in-patients-with-axial-spondyloarthritis-in-routine-care-2-year-clinical-and-mri-outcomes-and-predictors-of-successful-tapering/. Accessed .

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