Background/Purpose: The use of new treatment strategies in early stages of spondyloarthritis (SpA) makes it possible to achieve remission or low disease activity in more patients than before. Furthermore, one could speculate that there is a possibility of a “window of opportunity” for drug-free remission in peripheral SpA (pSpA), referring to the existence of a transient time frame in which the disease is more susceptible to treatment leading to better outcomes. The objective is to evaluate drug-free clinical remission after induction therapy with golimumab (GLM) in patients with active pSpA in a very early stage of the disease. To identify patient characteristics predicting sustained remission or occurrence of relapse after drug withdrawal.

Methods: CRESPA (Clinical REmission in peripheral SPondyloArthritis) is an ongoing monocentric study of golimumab treatment in pSpA patients. Eligible patients were ≥18 years and fulfilled the Assessment of SpondyloArthritis international Society (ASAS) classification criteria for pSpA. All patients had a symptom duration <12 weeks. Clinical remission was defined as the absence of arthritis, enthesitis and dactylitis on clinical examination. If patients were in clinical remission at two consecutive major visits (at week 12, 24, 36 and 48), treatment was withdrawn. Patients were prospectively followed to assess the rate of sustained drug-free clinical remission and clinical relapse.

Results: Patient demographics, baseline characteristics and 24-week results of the placebo-controlled phase have been described previously¹. 82% (49/60) of patients fulfilled sustained clinical remission criteria. At week 24, 30 patients already fulfilled criteria for sustained remission; at weeks 36 and 48, respectively  11 and 8 patients additionally reached this status. At present, 53% (26/49) of these patients are still in drug-free sustained clinical remission (follow-up between 18 and 58 months). The mean time for clinical relapse upon medication withdrawal was 31 weeks. Pre-existing psoriasis at baseline was predictive for clinical relapse whereas polyarticular disease (SJC>5) and psoriasis were not predictive for sustained clinical remission after treatment withdrawal. Fig 1 shows the percentages of patients that achieved sustained clinical remission, that are still in drug-free remission or experienced clinical relapse after treatment withdrawal for the total group and by subtype SpA.

Conclusion: Very early treatment with GLM resulted in sustained clinical remission in more than 80% of patients with pSpA, including PsA.  Upon drug withdrawal, more than 50% remain in drug-free remission (with a minimum follow-up of 18 months).  Clincial relapse is more often observed in PsA patients.  Retreatment with golimumab upon clinical relapse resulted in similar responses.

¹ Carron P, et al. Ann Rheum Dis Published Online First: 17 Feb 2017. doi:10.1136/annrheumdis-2016-210775