Occurrence and Prediction of Flare After Tapering of Tumor Necrosis Factor Inhibitors in Patients With Axial Spondyloarthritis
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Occurrence and Prediction of Flare After Tapering of Tumor Necrosis Factor Inhibitors in Patients With Axial Spondyloarthritis. / Wetterslev, Marie; Georgiadis, Stylianos; Christiansen, Sara Nysom; Pedersen, Susanne Juhl; Sørensen, Inge Juul; Hetland, Merete Lund; Duer, Anne; Boesen, Mikael; Gosvig, Kasper Kjærulf; Møller, Jakob Møllenbach; Bakkegaard, Mads; Brahe, Cecilie Heegaard; Krogh, Niels Steen; Jensen, Bente; Madsen, Ole Rintek; Christensen, Jan; Hansen, Annette; Nørregaard, Jesper; Røgind, Henrik; Østergaard, Mikkel.
I: Journal of Rheumatology, Bind 51, Nr. 1, 2024, s. 39-49.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Occurrence and Prediction of Flare After Tapering of Tumor Necrosis Factor Inhibitors in Patients With Axial Spondyloarthritis
AU - Wetterslev, Marie
AU - Georgiadis, Stylianos
AU - Christiansen, Sara Nysom
AU - Pedersen, Susanne Juhl
AU - Sørensen, Inge Juul
AU - Hetland, Merete Lund
AU - Duer, Anne
AU - Boesen, Mikael
AU - Gosvig, Kasper Kjærulf
AU - Møller, Jakob Møllenbach
AU - Bakkegaard, Mads
AU - Brahe, Cecilie Heegaard
AU - Krogh, Niels Steen
AU - Jensen, Bente
AU - Madsen, Ole Rintek
AU - Christensen, Jan
AU - Hansen, Annette
AU - Nørregaard, Jesper
AU - Røgind, Henrik
AU - Østergaard, Mikkel
N1 - Publisher Copyright: © 2024 The Journal of Rheumatology.
PY - 2024
Y1 - 2024
N2 - Objective. Patients with axial spondyloarthritis (axSpA) in clinical remission tapered tumor necrosis factor inhibitor (TNFi) therapy according to a clinical guideline. Over a 2-year follow-up period, we aimed to investigate flare frequency, dose at which flare occurred, type of flare, and predictors thereof. Methods. Patients in clinical remission (Bath Ankylosing Spondylitis Disease Activity Index [BASDAI] < 40, physician global score < 40, and without disease activity the previous year) tapered TNFi to two-thirds the standard dose at baseline, half at week 16, one-third at week 32, and discontinued at week 48. Flares were defined as BASDAI flare (BASDAI ≥ 40 and change ≥ 20 since inclusion), and/or clinical flare (development of inflammatory back pain, musculoskeletal or extraarticular manifestations, and/or Ankylosing Spondylitis Disease Activity Score [ASDAS] ≥ 0.9), and/or magnetic resonance imaging (MRI) flare (≥ 2 new or worsened inflammatory lesions). Results. Of 108 patients, 106 (99%) flared before 2-year follow-up: 29 patients (27%) at two-thirds standard dose, 21 (20%) at half dose, 29 (27%) at one-third dose, and 27 (25%) after discontinuation. Regarding type of flare, 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%) fulfilled the Assessment of SpondyloArthritis international Society (ASAS) definition of clinically important worsening (≥ 0.9 increase since baseline). Higher baseline physician global score was an independent predictor of flare after tapering to two-thirds (OR 1.19, 95% CI 1.04-1.41, P = 0.01). Changes in clinical and/or imaging variables in the 16 weeks prior to tapering did not predict flare. 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.
AB - Objective. Patients with axial spondyloarthritis (axSpA) in clinical remission tapered tumor necrosis factor inhibitor (TNFi) therapy according to a clinical guideline. Over a 2-year follow-up period, we aimed to investigate flare frequency, dose at which flare occurred, type of flare, and predictors thereof. Methods. Patients in clinical remission (Bath Ankylosing Spondylitis Disease Activity Index [BASDAI] < 40, physician global score < 40, and without disease activity the previous year) tapered TNFi to two-thirds the standard dose at baseline, half at week 16, one-third at week 32, and discontinued at week 48. Flares were defined as BASDAI flare (BASDAI ≥ 40 and change ≥ 20 since inclusion), and/or clinical flare (development of inflammatory back pain, musculoskeletal or extraarticular manifestations, and/or Ankylosing Spondylitis Disease Activity Score [ASDAS] ≥ 0.9), and/or magnetic resonance imaging (MRI) flare (≥ 2 new or worsened inflammatory lesions). Results. Of 108 patients, 106 (99%) flared before 2-year follow-up: 29 patients (27%) at two-thirds standard dose, 21 (20%) at half dose, 29 (27%) at one-third dose, and 27 (25%) after discontinuation. Regarding type of flare, 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%) fulfilled the Assessment of SpondyloArthritis international Society (ASAS) definition of clinically important worsening (≥ 0.9 increase since baseline). Higher baseline physician global score was an independent predictor of flare after tapering to two-thirds (OR 1.19, 95% CI 1.04-1.41, P = 0.01). Changes in clinical and/or imaging variables in the 16 weeks prior to tapering did not predict flare. 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.
KW - axial spondyloarthritis
KW - drug tapering
KW - flare
KW - magnetic resonance imaging
KW - patient-reported outcomes measures
KW - tumor necrosis factor inhibitors
U2 - 10.3899/jrheum.2023-0495
DO - 10.3899/jrheum.2023-0495
M3 - Journal article
C2 - 37839816
AN - SCOPUS:85181569047
VL - 51
SP - 39
EP - 49
JO - Journal of Rheumatology
JF - Journal of Rheumatology
SN - 0315-162X
IS - 1
ER -
ID: 379714040