Nearly All Patients in AxSpA Remission Flare After TNFi Tapering
Some 99% of patients with axial spondyloarthritis (axSpA) in clinical remission flared within 2 years of tapering tumor necrosis factor inhibitor (TNFi) therapy, according to study results published online ahead of print in The Journal of Rheumatology.
The study included 108 patients in clinical remission at baseline. In accordance with a clinical guideline, patients tapered TNFi therapy to two-thirds of the standard dose at baseline, half the standard dose at week 15, one-third the standard dose at week 32, and discontinuation at week 48.
Among the 108 patients followed over 2 years, 106 flared, according to the study. Flare occurred at two-thirds of the standard TNFi dose for 27% of the patients, at half the standard dose for 20%, at one-third the standard dose for 27%, and after discontinuation for 25%.
“Almost all (99%) axSpA patients in clinical remission flared during tapering to discontinuation, but above half not before receiving 1/3 dose or less,” wrote first author Marie Wetterslev, MD, PhD, of the University Hospital of Copenhagen in Denmark, and study coauthors.
Ninety-nine percent of patients met the criteria for a clinical flare, which researchers defined as the development of inflammatory back pain, musculoskeletal, or extra-articular manifestations, or an increase of 0.9 or more points on the Ankylosing Spondylitis Disease Activity Score (ASDAS) with C-reactive protein. Some 41% of patients met the Assessment of SpondyloArthritis International Society’s definition of clinically important worsening, an ASDAS increase of at least 0.9 points.
Meanwhile, 24% of patients met criteria for a Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) flare, which was defined as a BASDAI score of 40 or greater or a BASDAI increase of 20 points or more. Of patients with magnetic resonance imaging (MRI) data, 29% met the criteria for MRI flare, defined as 2 or more new or worsened inflammatory lesions.
Analysis identified a higher baseline physician global score as an independent predictor of flare after tapering to two-thirds of the standard TNFi dose; researchers reported an odds ratio of 1.19. In contrast, changes in clinical and/or imaging variables in the 16 weeks prior to tapering did not predict flare.
Reference
Wetterslev M, Georgiadis S, Nysom Christiansen S, et al. Occurrence and prediction of flare after tapering of tumor necrosis factor inhibitors in patients with axial spondyloarthritis. J Rheumatol. Published online October 15, 2023. doi:10.3899/jrheum.2023-0495
