Date: Sunday, November 7, 2021
Session Type: Poster Session B
Session Time: 8:30AM-10:30AM
Background/Purpose: Patients with axial spondyloarthritis (axSpA) in clinical remission tapered Tumor Necrosis Factor inhibitor (TNFi) treatment according to a clinical guideline and were followed for 2-years. We aimed to investigate 1) potential ‘baseline’ predictors of flare within 16 weeks after tapering to 2/3, 1/2, 1/3 and 0 of standard dose and 2) if change in clinical and/or imaging variables in the previous 16-weeks (i.e. during the previous dose reduction step) could predict flare within 16 weeks after tapering to 1/2, 1/3 and 0 dose.
Methods: In all, 109 patients (78(72%) on standard dose, 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 magnetic resonance imaging (MRI) flare stopped tapering and escalated to the previous dose. Prediction analyses were done by multivariable regression.
Results: Of 107 patients who followed the tapering algorithm for 2 years, 106 patients flared: 30 (28%) flared at 2/3 of standard dose, 20 (19%) at 1/2, 29 (27%) at 1/3 and 27 (25%) after discontinuation of TNFi (Table 1). Of the 106 patients who flared, 105 had clinical flare, 25 BASDAI flare and 23 MRI flare (Figure 1). Higher baseline physician global score was an independent predictor of flare after tapering to 2/3 (Odds ratio (OR)=1.21 (95% Confidence Interval=1.05 to1.44); p=0.007). When changes from baseline to week 16 in addition to demographics were investigated as predictors of flare, higher age predicted flare within 16 weeks after tapering to 1/2 dose (OR=1.07(1.01 to 1.15); p=0.015) (Table 2). Prediction analyses on lower dose steps were not possible due to small sample sizes.
Conclusion: In axSpA patients in clinical remission who tapered TNFi according to a clinical guideline, higher baseline physician global score was the only independent predictor of flare within 16 weeks after tapering to 2/3 of standard dose.
To cite this abstract in AMA style:Wetterslev M, Georgiadis S, Christiansen S, Juhl Pedersen S, Sørensen I, Lund Hetland M, Duer A, Boesen M, Kjærulf Gosvig K, Møllenbach Møller J, Bakkegaard M, Heegaard Brahe C, Krogh N, Jensen B, Rintek Madsen O, Christensen J, Hansen A, Nørregaard J, Røgind H, Ostergaard M. Tapering of TNF Inhibitors in Patients with Axial Spondyloartritis – Can Flare Be Predicted? [abstract]. Arthritis Rheumatol. 2021; 73 (suppl 10). https://acrabstracts.org/abstract/tapering-of-tnf-inhibitors-in-patients-with-axial-spondyloartritis-can-flare-be-predicted/. Accessed January 28, 2022.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/tapering-of-tnf-inhibitors-in-patients-with-axial-spondyloartritis-can-flare-be-predicted/