Photo Credit: Magicmine
In a retrospective study on axial spondyloarthritis (axSpA) patients tapering tumor necrosis factor inhibitor (TNFi) therapy, 99% experienced flares before the 2-year follow-up, with higher initial disease activity predicting earlier flares.
The following is a summary of “Occurrence and Prediction of Flare After Tapering of Tumor Necrosis Factor Inhibitors in Patients With Axial Spondyloarthritis,” published in the January 2024 issue of Rheumatology by Wetterslev et al.
Researchers conducted a retrospective study tracking flare frequency, dose dependence, and predictors in axial spondyloarthritis (axSpA) patients tapering tumor necrosis factor inhibitor (TNFi) therapy over 2 years.
They tapered TNFi doses for patients in clinical remittals (Bath Ankylosing Spondylitis Disease Activity Index [BASDAI] < 40, physician global score < 40, and no disease activity in the last year). The tapering, two-thirds at BL, half at week 16, one-third at week 32, and discontinuation at week 48. Flares were explained as BASDAI flare (BASDAI ≥ 40 and change ≥ 20 since inclusion), clinical flare (onset of inflammatory back pain, musculoskeletal or extraarticular manifestations, and Ankylosing Spondylitis Disease Activity Score [ASDAS] ≥ 0.9), and MRI flare (≥ 2 new or worsened inflammatory lesions).
The results showed 106/108 patients (99%) experienced flares before the 2-year follow-up: 29 patients (27%) at two-thirds of the standard dose, 21 (20%) at half the dose, 29 (27%) at one-third of the dose, and 27 (25%) after discontinuation. In terms of flare type, 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%) met the Assessment of SpondyloArthritis International A baseline physician global score independently predicted flare after tapering to two-thirds (ASAS definition, ≥ 0.9 increase since BL, OR 1.19, 95% CI 1.04-1.41, P=0.01). Clinical and/or imaging changes in the 16 weeks before tapering did not predict flare.
They concluded that AxSpA patients (99%) flared on TNFi withdrawal, but half only after significantly reduced doses, with higher initial disease activity predicting earlier flares.
Source: jrheum.org/content/51/1/39