Spondyloarthritis & psoriatic arthritis
Occurrence and Prediction of Flare After Tapering of Tumor Necrosis Factor Inhibitors in Patients With Axial Spondyloarthritis
Authors' 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.
Study context
- Population
- Patients with axial spondyloarthritis (axSpA) in clinical remission (BASDAI < 40, physician global score < 40, and without disease activity the previous year)
- Participants
- 108 patients
- Outcome
- Flare (BASDAI flare, clinical flare and/or MRI flare) during TNFi tapering
- Follow-up
- 2 years
Methodological detailssingle-group, guideline-based tumor necrosis factor inhibitor (TNFi) tapering to discontinuation, 2-year follow-up
- Single-group
- Guideline-based TNFi tapering to discontinuation
- 2-year follow-up
Main finding
As reported in the abstract
Flare before 2-year follow-up
- Patients who flared, n (%)
- 106 (99%)
- Flared at two-thirds standard dose, n (%)
- 29 (27%)
- Flared at half dose, n (%)
- 21 (20%)
- Flared at one-third dose, n (%)
- 29 (27%)
- Flared after discontinuation, n (%)
- 27 (25%)
Observational data: associations, not effects.
Further findings
Type of flare
- Clinical flare, n (%)
- 105 (99%)
- BASDAI flare, n (%)
- 25 (24%)
- Magnetic resonance imaging (MRI) flare, n (% of patients with MRI at flare available)
- 23 (29%)
ASAS clinically important worsening (≥ 0.9 increase since baseline)
- Patients fulfilling definition, n (%)
- 41 (41%)
Predictor of flare after tapering to two-thirds: higher baseline physician global score
- OR (95% CI 1.04-1.41), P = 0.01; independent predictor
- 1.19
Changes in clinical and/or imaging variables in the 16 weeks prior to tapering
- Did not predict flare
Original publication
Occurrence and Prediction of Flare After Tapering of Tumor Necrosis Factor Inhibitors in Patients With Axial Spondyloarthritis. J Rheumatol. Published 15 October 2023. doi:10.
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