Occurrence and Prediction of Flare After Tapering of Tumor Necrosis Factor Inhibitors in Patients With Axial Spondyloarthritis
Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
Methods Patients in clinical remission (Bath Ankylosing Spondylitis Disease Activity Index [BASDAI] < 40, physician global score < 40, and without disease activity the previous year) tapered TNFi to two-thirds the standard dose at baseline, half at week 16, one-third at week 32, and discontinued at week 48. Flares were defined as BASDAI flare (BASDAI ≥ 40 and change ≥ 20 since inclusion), and/or clinical flare (development of inflammatory back pain, musculoskeletal or extraarticular manifestations, and/or Ankylosing Spondylitis Disease Activity Score [ASDAS] ≥ 0.9), and/or magnetic resonance imaging (MRI) flare (≥ 2 new or worsened inflammatory lesions).
Results Of 108 patients, 106 (99%) flared before 2-year follow-up: 29 patients (27%) at two-thirds standard dose, 21 (20%) at half dose, 29 (27%) at one-third dose, and 27 (25%) after discontinuation. Regarding type of flare, 105 (99%) had clinical flares, 25 (24%) had BASDAI flares, and 23 (29% of patients with MRI at flare available) had MRI flares. Forty-one patients (41%) fulfilled the Assessment of SpondyloArthritis international Society (ASAS) definition of clinically important worsening (≥ 0.9 increase since baseline). Higher baseline physician global score was an independent predictor of flare after tapering to two-thirds (OR 1.19, 95% CI 1.04-1.41, P = 0.01). Changes in clinical and/or imaging variables in the 16 weeks prior to tapering did not predict flare.
Conclusion Almost all (99%) patients with axSpA in clinical remission experienced flare during tapering to discontinuation, but in over half of these patients, flare did not occur before receiving one-third dose or less. Higher physician global score was an independent predictor of flare.
| Originalsprog | Engelsk |
|---|---|
| Tidsskrift | Journal of Rheumatology |
| Vol/bind | 51 |
| Udgave nummer | 1 |
| Sider (fra-til) | 39-49 |
| Antal sider | 11 |
| ISSN | 0315-162X |
| DOI | |
| Status | Udgivet - 2024 |
Bibliografisk note
Funding Information:
This quality control study was supported by Center for Rheumatology and Spine Diseases, Center for Head and Orthopaedics, University Hospital of Copenhagen, Rigshospitalet. MW was supported with a PhD fellowship grant (R131-A5381) from the Danish Rheumatism Association. 1M. Wetterslev, MD, PhD, S. Georgiadis, PhD, S. Nysom Christiansen, MD, PhD, S. Juhl Pedersen, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, University Hospital of Copenhagen, Rigshospitalet, Glostrup; 2I. Juul Sørensen, MD, PhD, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, University Hospital of Copenhagen, Rigshospitalet, Copenhagen; 3M. Lund Hetland, MD, PhD, DMSc, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, University Hospital of Copenhagen, Rigshospitalet, Glostrup, and Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, and The DANBIO Registry, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, University Hospital of Copenhagen, Rigshospitalet, Glostrup; 4A. Duer, MD, PhD, Department of Radiology, Rigshospitalet, Glostrup, Copenhagen; 5M. Boesen, MD, PhD, DMSc, Department of Radiology, Bispebjerg and Frederiksberg Hospital, Copenhagen; 6K.K. Gosvig, MD, PhD, J.M. Møller, PhD, Department of Radiology, Herlev and Gentofte Hospital, Copenhagen; 7M. Bakkegaard, MD, J. Nørregaard, MD, PhD, H. Røgind, MD, PhD, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, University Hospital of Copenhagen, Rigshospitalet, Glostrup; 8C. Heegaard Brahe, MD, PhD, B. Jensen, MD, PhD, J. Christensen, MD, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, University Hospital of Copenhagen, Frederiksberg and Bispebjerg Hospital, Copenhagen; 9N.S. Krogh, Zitelap Aps, Copenhagen; 10O.R. Madsen, MD, PhD, A. Hansen, MD, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, University Hospital of Copenhagen, Herlev, and Gentofte Hospital, Copenhagen; 11M. Østergaard, MD, PhD, DMSc, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, University Hospital of Copenhagen, Rigshospitalet, Glostrup, and Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark.
Funding Information:
We acknowledge the contribution of secretaries, laboratory technicians, radiographers, nurses, and physicians in the implementation of the guideline. The work was presented at American College of Rheumatology’s 2021 annual meeting (abstract no. 0929, Arthritis Rheumatol, 2021; 73 [Suppl 10]) and at the European Alliance of Associations for Rheumatology’s 2022 annual meeting (abstract no. 654, Ann Rheum Dis 2022, 81 [Suppl 1] 396).
Publisher Copyright:
© 2024 The Journal of Rheumatology.
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