Spondyloarthritis & psoriatic arthritis
The influence of symptom duration on flare risk after biologic DMARD withdrawal in axial spondyloarthritis: A meta-analysis of randomized withdrawal trials
Authors' conclusion
Symptom duration did not consistently modify flare risk after bDMARD withdrawal in axSpA overall, although exploratory findings suggest a potential effect in early nr-axSpA.
Study context
- Population
- Adults with axial spondyloarthritis (axSpA) who achieved inactive disease or remission by ASDAS
- Participants
- 773 adults3 RCTs
- Comparison
- Continuation vs withdrawal of b/tsDMARDs, stratified by symptom duration
- Outcome
- Effect modification of flare risk (continuation vs withdrawal) by symptom duration, as RRR
Methodological detailsrandom-effects meta-analysis, stratified by symptom duration thresholds, subgroup analysis in nr-axSpA, Patient-level data obtained from Vivli, No tsDMARD or tapering studies eligible
- Random-effects meta-analysis
- Stratified by symptom duration thresholds
- Subgroup analysis in nr-axSpA
- Patient-level data obtained from Vivli
- No tsDMARD or tapering studies eligible
Pooled result
As reported in the abstract
Effect modification of flare risk (continuation vs withdrawal) by symptom duration, overall axSpA, pooled RRR
RRR
- ≤2years
- 0.61 (95% CI 0.29–1.28)
- ≤3years
- 0.77 (95% CI 0.54–1.12)
- ≤4years
- 0.83 (95% CI 0.45–1.54)
- ≤5years
- 0.82 (95% CI 0.49–1.37)
Further pooled results
| Outcome | RRR (CI) |
|---|---|
| Effect modification by symptom duration in nr-axSpA (subgroup, n=508), pooled RRRFavoured shorter symptom duration | 0.25 (0.07–0.96) |
Effect modification by symptom duration in nr-axSpA (subgroup, n=508), pooled RRR
- Not favouring shorter symptom duration at ≤2, ≤3 or ≤5years
Original publication
The influence of symptom duration on flare risk after biologic DMARD withdrawal in axial spondyloarthritis: A meta-analysis of randomized withdrawal trials. Joint Bone Spine. Published 24 July 2026. doi:10.
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