Occurrence and Prediction of Flare After Tapering of Tumor Necrosis Factor Inhibitors in Patients With Axial Spondyloarthritis

被引:3
|
作者
Wetterslev, Marie [1 ,15 ]
Georgiadis, Stylianos [1 ]
Christiansen, Sara Nysom [1 ]
Pedersen, Susanne Juhl [1 ]
Sorensen, Inge Juul [1 ,2 ]
Hetland, Merete Lund [1 ,3 ,4 ,5 ]
Duer, Anne [6 ]
Boesen, Mikael [7 ]
Gosvig, Kasper Kjaerulf [8 ]
Moller, Jakob Mollenbach
Bakkegaard, Mads [9 ]
Brahe, Cecilie Heegaard [10 ]
Krogh, Niels Steen [11 ]
Jensen, Bente [10 ]
Madsen, Ole Rintek [12 ,13 ]
Christensen, Jan [10 ]
Hansen, Annette [12 ,13 ]
Norregaard, Jesper [9 ]
Brahe, Heegaard
Ostergaard, Mikkel [1 ,14 ]
机构
[1] Univ Hosp Copenhagen, Copenhagen Ctr Arthrit Res, Ctr Rheumatol & Spine Dis, Ctr Head & Orthopaed,Rigshosp, Glostrup, Denmark
[2] Univ Hosp Copenhagen, Ctr Rheumatol & Spine Dis, Ctr Head & Orthopaed, Rigshosp, Copenhagen, Denmark
[3] Univ Copenhagen, Univ Hosp Copenhagen, Fac Hlth & Med Sci, Copenhagen Ctr Arthrit Res,Rigshosp, Copenhagen, Denmark
[4] Univ Copenhagen, Fac Hlth & Med Sci, Dept Clin Med, Copenhagen, Denmark
[5] Univ Hosp Copenhagen, Ctr Rheumatolog & Spine Dis, Ctr Head & Orthopaed, DANBIO Registry,Rigshosp, Glostrup, Denmark
[6] Rigshosp, Dept Radiol, Copenhagen, Denmark
[7] Bispebjerg & Frederiksberg Hosp, Dept Radiol, Copenhagen, Denmark
[8] Herlev & Gentofte Hosp, Dept Radiol, Copenhagen, Denmark
[9] Univ Hosp Copenhagen, Ctr Rheumatol & Spine Dis, Ctr Head & Orthopaed, Rigshosp, Glostrup, Denmark
[10] Univ Hosp Copenhagen, Frederiksberg & Bispebjerg Hosp, Ctr Rheumatol & Spine Dis, Ctr Head & Orthopaed, Copenhagen, Denmark
[11] Zitelap Aps, Copenhagen, Denmark
[12] Univ Hosp Copenhagen, Ctr Rheumatol & Spine Dis, Ctr Head & Orthopaed, Herlev, Denmark
[13] Gentofte Univ Hosp, Copenhagen, Denmark
[14] Univ Copenhagen, Fac Hlth & Med Sci, Dept Clin Med, Copenhagen, Denmark
[15] Rigshosp, Ctr Rheumatol & Spine Dis, Copenhagen Ctr Arthrit Res, Ctr Head & Orthoped, Valdemar Hansens Vej 17, DK-2600 Glostrup, Denmark
关键词
axial spondyloarthritis; drug tapering; flare; magnetic resonance imaging; patient- reported outcomes measures; tumor necrosis factor inhibitors; RESONANCE-IMAGING INDEX; ANKYLOSING-SPONDYLITIS; RESEARCH CONSORTIUM; CLINICAL REMISSION; DOSE REDUCTION; LONG-TERM; DISCONTINUATION; ETANERCEPT; INFLAMMATION; VALIDATION;
D O I
10.3899/jrheum.2023-0495
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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.
引用
收藏
页码:39 / 49
页数:11
相关论文
共 50 条
  • [31] Drug Survival of Tumour Necrosis Factor-α Inhibitors in Patients with Ankylosing Spondylitis and Axial Spondyloarthritis
    Chu, Raymond
    Chow, Andrew
    Soucy, Elaine
    Bhatt, Palki
    Got, Tiffany
    Hong, Daniel
    JOURNAL OF RHEUMATOLOGY, 2015, 42 (07) : 1331 - 1331
  • [32] Axial Spondyloarthritis: Can Flare-ups be predicted during TNFi Tapering?
    Brudermanns, Britta
    AKTUELLE RHEUMATOLOGIE, 2024, 49 (05) : 289 - 289
  • [33] Profiling Response to Tumor Necrosis Factor Inhibitor Treatment in Axial Spondyloarthritis
    Alazmi, Mansour
    Sari, Ismail
    Krishnan, Bharath
    Inman, Robert D.
    Haroon, Nigil
    ARTHRITIS CARE & RESEARCH, 2018, 70 (09) : 1393 - 1399
  • [34] Impact of Smoking in Response to Tumor Necrosis Factor Inhibitors in Axial Spondyloarthritis: Methodologic Considerations for Longitudinal Observational Studies
    Zhao, Sizheng Steven
    Yoshida, Kazuki
    Jones, Gareth T.
    Hughes, David M.
    Tedeschi, Sara K.
    Lyu, Houchen
    Moots, Robert J.
    Solomon, Daniel H.
    Goodson, Nicola J.
    ARTHRITIS CARE & RESEARCH, 2020, 72 (04) : 591 - 599
  • [35] Discontinuing tumour necrosis factor inhibitors in non-radiographic axial spondyloarthritis
    Braun, Juergen
    LANCET, 2018, 392 (10142): : 98 - 100
  • [36] Tumor necrosis factor-α (TNFα) inhibitors in the treatment of nonradiographic axial spondyloarthritis: current evidence and place in therapy
    Rodriguez, Valeria Rios
    Poddubnyy, Denis
    THERAPEUTIC ADVANCES IN MUSCULOSKELETAL DISEASE, 2017, 9 (08) : 197 - 210
  • [37] Impaired response to treatment with tumour necrosis factor α inhibitors in smokers with axial spondyloarthritis
    Ciurea, Adrian
    Scherer, Almut
    Weber, Ulrich
    Exer, Pascale
    Bernhard, Juerg
    Tamborrini, Giorgio
    Riek, Myriam
    Mueller, Ruediger B.
    Weiss, Bettina
    Nissen, Michael J.
    Kissling, Rudolf
    Michel, Beat A.
    Finckh, Axel
    ANNALS OF THE RHEUMATIC DISEASES, 2016, 75 (03) : 532 - 539
  • [38] Tumor necrosis factor-alpha inhibitors may increase the need for fine-needle aspiration cytology in axial spondyloarthritis patients
    Sayiner, Zeynel Abidin
    Munis, Hayriye Sultan
    Koroglu, Ipek
    Akyol, Elif Melis Baloglu
    Zengin, Orhan
    Akarsu, Ersin
    REVISTA DA ASSOCIACAO MEDICA BRASILEIRA, 2024, 70 (12):
  • [39] A Delayed Effect of Tumor Necrosis Factor Inhibitors on Radiographic Spinal Progression in Patients with Axial Spondyloarthritis: Long-term Results from the German Spondyloarthritis Inception Cohort
    Poddubnyy, Denis
    Rodriguez, Valeria Rios
    Torgutalp, Murat
    Dilbaryan, Ani
    Verba, Maryna
    Protopopov, Mikhail
    Proft, Fabian
    Rademacher, Judith
    Haibel, Hildrun
    Sieper, Joachim
    Rudwaleit, Martin
    ARTHRITIS & RHEUMATOLOGY, 2020, 72
  • [40] Impact of tumor necrosis factor α inhibitors on MRI inflammation in axial spondyloarthritis assessed by Spondyloarthritis Research Consortium Canada score: A meta-analysis
    Huang, Yupeng
    Chen, Yuehong
    Liu, Tao
    Lin, Sang
    Yin, Geng
    Xie, Qibing
    PLOS ONE, 2020, 15 (12):