Response to lower dose TNF inhibitors in axial spondyloarthritis; a real-world multicentre observational study

Abstract

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.

To taper or not to taper biological disease-modifying antirheumatic drugs in axial spondyloarthritis anno 2023: That is the question

“…All patients who experienced relapse under reduced dose regained disease activity control after increasing the dose back to the original one. Interestingly, a successful dose reduction was negatively associated with female sex [56]. Disease activity-guided dose optimization of TNFi has been retrospectively analyzed in a Dutch cohort of axSpA and PsA patients [57].…”