Objective
Dose optimisation of TNF inhibitors in axial spondyloarthritis (axSpA) is attractive but it is unclear for which patients this approach might be appropriate.
Methods
Seventy-one patients, from 6 UK centres, with axSpA who had reduced their dose of TNFi, after being considered to be stable responders were identified. All completed a questionnaire concerning their approach to and experience of dose reduction. Data on patient characteristics, metrology and CRP were retrieved retrospectively from patient records.
Results
Over two years of observation, 60 (84.5%) remained (REM) on reduced-dose medication and 11 (15.5%) reverted (REV) to the original dose. Overall mean dose reduction was 39% and 44% for REM and REV patients respectively. Both groups responded similarly to treatment initially, but the data showed a trend that younger women were more likely to revert. Neither BMI nor smoking was associated with continued low-dose responsiveness. Eight of the 11 REV patients reverted by 6 months. None reached criteria of secondary drug failure and all regained control after increasing back to the original dose. Most patients in both groups reached the decision to dose-reduce jointly with clinicians. Preference for taking the reduced dose was not associated with low dose drug survival.
Conclusion
Many patients with axSpA remain well symptomatically after stepping down the dose of TNFi but young women are less likely to do well on a reduced dose. Dose-reduction should be one element of the management of patient with axSpA.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.