Comparing Tapering Strategy to Standard Dosing Regimen of Tumor Necrosis Factor Inhibitors in Patients with Spondyloarthritis in Low Disease Activity

Abstract

The tapering strategy in SpA results in an important reduction of the drug administered, and the disease control remains similar to that of the patients with SpA receiving the standard regimen.

Practical recommendations for the use of therapeutic drug monitoring of biopharmaceuticals in inflammatory diseases

“…If the drug concentration is below the therapeutic range in a patient, dose increase, interval shortening or a combination may be considered. Besides treatment intensification, TDM also includes the possibility of giving insights for reducing the exposure when needed, by reestablishing the standard dosing interval and/or dose de-escalation 14,15,70–72. These interventions have been integrated in TDM algorithms, for example, the Trough concentration Adapted infliXImab Treatment (TAXIT) algorithm, which can be used for optimizing maintenance infliximab therapy in patients with IBD 12.…”

“…Furthermore, ADA have been detected toward etanercept (although non-neutralizing antibodies), rituximab, tocilizumab and abatacept, but no impact on drug exposure and response has been observed 18,31,91,95,96. TDM-based treatment optimization of infliximab, adalimumab and etanercept has been explored in a few studies, overall suggesting a cost-effectiveness 13,14,16,35,97. The utility of TDM of rituximab, tocilizumab and abatacept remains unclear 18…”

Dose-Tapering Of TNF Inhibitors in Daily Rheumatology Practice Enables the Maintenance of Clinical Efficacy While Improving Cost-Effectiveness

“…A flare was defined as an increase of the DAS28-ESR (a composite score measuring disease activity) greater than 3.2 plus a delta-DAS28 (related to pre-tapering DAS28) lower than -0.6 in RA patients and BASDAI ≥ 4 and delta-BASDAI ≤-2 (related to pre-tapering BASDAI) in SpA patients in at least one clinical visit during the study [20,26]. In the case of a flare, the concomitant therapy (disease-modifying antirheumatic drugs-DMARDS-, nonsteroidal anti-inflammatory drug -NSAIDS-, corticosteroids) could be intensified in both periods, but the TNFinhibitor therapy was only increased in the 2 nd P.…”

“…A good clinical response is mainly associated to elevated serum drug levels and a low frequency of anti-drug antibody detection. However, the optimal drug levels required to maintain stable LDA or clinical remission are unknown [20].…”

Flare in axial spondyloarthritis. The dark side of the outcome

“…The definition of a flare and proposition of a simple tool is important, for studies, as mentioned by Gossec13 (and some studies may be designed with flare as outcome, particularly management of remission and dosage reduction16 20), and in real life for the patient. Patient self-evaluation between two visits may allow detection and recognition of a disease deterioration as a flare, and initiate a rapid contact with the rheumatologist for treatment adaptation, in a tight control treatment strategy.…”