Effects of tapering tumor necrosis factor inhibitor on the achievement of inactive disease in patients with axial spondyloarthritis: a nationwide cohort study

Abstract

Objectives To investigate the association between the extent of tapering tumor necrosis factor inhibitor (TNFi) and the likelihood of achieving inactive disease in patients with axial spondyloarthritis (axSpA) Methods We analyzed 1575 1-year follow-up interval data of 776 axSpA patients treated with TNFi for more than 1 year in a nationwide observational cohort. The decision on tapering TNFi was made by patients and their physicians. We quantified TNFi used during interval as a dose quotient (DQ). The intervals were classified into the heavy-tapering (DQ < 50), mild-tapering (DQ 50–99), and control groups (DQ = 100). Outcome variables included achieving Ankylosing Spondylitis Disease Activity Score-inactive disease (ASDAS-ID) and major clinical response of Bath Ankylosing Spondylitis Disease Activity Index (BASDAI50) in the follow-up visit. The effects of TNFi tapering on the outcome were analyzed using the generalized estimating equation. Results At the baseline visit, 91.1% of the patients showed a high disease activity (ASDAS-CRP ≥ 2.1). DQ of each interval was significantly influenced by the ASDAS-CRP measure in the prior follow-up ( P < 0.001). ASDAS-ID was observed in 42.3% of the intervals. A multivariable analysis showed that the likelihood of outcome achievement was comparable between the control and mild-tapering groups, but significantly decreased in the heavy-tapering group (vs. the control group, adjusted OR = 0.28, [95% CI, 0.08–0.94]). In contrast, the likelihood to achieve BASDAI50 response was not different among the groups. In the subgroup of patients who reached ASDAS-ID 1 year after TNFi treatment ( n = 327), ASDAS-ID was observed in 66.1% of the subsequent intervals, and only the mild-tapering group showed a likelihood of target maintenance comparable with that of the control group (adjusted OR = 1.25 [0.41–3.80]). This likelihood decreased with an increase in ASDAS-CRP. Conclusion Mild tapering of TNFi has efficacy comparable with that of the standard-dose treatment for ASDAS-ID achievement in patients with axSpA. Electronic supplementary material The online version of this article (10.1186/s13075-019-1943-6) contains supplementary material, which is available to authorized users.

Impact of tapering targeted therapies (bDMARDs or JAKis) on the risk of serious infections and adverse events of special interest in patients with rheumatoid arthritis or spondyloarthritis: a systematic analysis of the literature and meta-analysis

“…Several studies [19][20][21][22] have highlighted that discontinuation of targeted therapies, more so in RA than in SpA, leads to an increased risk of relapse and radiographic progression, while tapering strategies does not seem to increase this risk when compared with continuing the initial treatment.…”

Dose Reduction of Tumor Necrosis Factor Inhibitor and its Effect on Medical Costs for Patients with Ankylosing Spondylitis

“…To compare the treatment patterns among TNFis, dosing was standardized. In a manner similar to that in previous studies [ 23 , 24 ], our data are presented with the recommended weekly doses. Moreover, we strictly defined dose reduction as a decrease in the dose by more than 50%.…”

“…To compare the treatment patterns among TNFis, dosing was standardized. In a manner similar to that in previous studies [23,24], our data are presented with the recommended A few clinical studies have reviewed the dose reduction of biologics in patients with AS. In a randomized controlled study, remission was maintained in 86.3% of patients who received 50 mg etanercept every alternate week and in 90.4% of patients who received 50 mg etanercept every week [25].…”

The Aftermath of Tapering Tocilizumab After Achieving Treatment Target In Patients With Rheumatoid Arthritis: A Nationwide Cohort Study

“…The dose and interim of TCZ therapy in each one-year interval was converted to a dose quotient (DQ), calculated as (mean actual dose/standard dose) × (standard − dosing interval/mean actual dosing interval) × 100 [21,22]. Each 1-year interval was classi ed into the control (DQ = 100) and tapered group (DQ < 100) according to the DQ of the interval.…”