Date: Saturday, November 6, 2021
Session 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.
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 June 7, 2023.
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