Background The effectiveness of TNF blockers in treating axial Spondyloarthritis is well-known but there are a few evidence on the dosage reduction in patients in persistent clinical remission (1-4).
Objectives Our objective was to assess the percentage of patients with axial Spondyloarthritis in persistent remission who received low dosages of biological therapy which remained in clinical remission or low disease activity (LDA) at 3, 6 and 12 months of follow-up.
Methods We performed a prospective, observational study of 12 months of follow-up, selecting patients from our department with axial Spondyloarthritis fulfilling the ASAS criteria, including Ankylosing Spondylitis, in persistent clinical remission (BASDAI ≤2, absence of arthritis and enthesitis and normality of CRP values) for a minimum of 6 months without NSAIDs consume, who received low dosages of TNF blockers until September 2012 according to an established protocol (Etanercept 50 mg every 10 days or 25 mg every week, Infliximab 3mg/kg every 8 weeks and Adalimumab 40 mg every 3 weeks). Baseline characteristics analysed were: age, sex, smoking status, diagnosis, HLAB27 positivity, peripheral involvement, previous uveitis, combined therapy with synthetic disease-modifying antirheumatic drugs (sDMARD), high CRP and ESR levels before biological therapy (PCR >0,6mg/dl and ESR >20mm/hour), structural damage in spine, duration of clinical remission, disease duration, type and duration of biological agent used. At 3, 6 and 12 months of follow-up we assessed the percentage of patients which remained in clinical remission (BASDAI ≤2), the percentage in LDA (BASDAI between 2 and 4 units) and the percentage who relapsed (BASDAI ≥4) and required the previous dose of biological treatment.
Results We included 42 patients (73,8% man) with a mean age of 41,2±12,2 years. The diagnosis were: 33 Ankylosing Spondylitis, 7 non-radiographic axial Spondyloarthritis and 2 Spondyloarthritis associated with bowel inflammatory disease and 76,2% had HLAB27 positive. 42,8% of patients were smokers, 50% had peripheral involvement, 16,6% had previous uveitis, 9,5% were receiving sDMARDs, 73,8% had high CRP levels and 57,1% had high ESR levels before biological therapy and 45,2% had structural damage in spine. They had a mean time of remission of 27,5±18,2 months and they had a disease duration of 6,6±5,7 years. 8 patients received Etanercept, 7 Infliximab and 27 Adalimumab and a mean duration of current biological therapy was 40,7±23,7 months. At 3 months of follow-up 85,7% of patients remained in remission, 9,5% had LDA and 5% relapsed. AT 6 months 76,2% remained in remission, 7,1% had LDA and 16,7% relapsed. AT 12 months 69,1% remained in remission, el 7,1% had LDA and 23,8% relapsed.
Conclusions Most of our patients with axial Spondylarthritis remained in clinical remission at 3, 6 and 12 months after dosage reduction of TNF blockers. Only a small percentage of the patients relapsed and required the previous dose of biological treatment.
Navarro-Compán V. et al, Clin Rheumatol 2011;30:993-6.
Paccou J. et al, J Rheumatol 2012;39:1418-23.
De Stefano R. et al, Clin Rheumatol 2013 Sep 6.
Cantini F,. et al, Biologics 2013;7:1-6.
Disclosure of Interest None declared
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