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SAT0334 Comparison of Clinical Outcomes between Spondyloarthritis Patients Treated with TNF Inhibitors in Daily Clinical Practise: Tapering versus Standard Therapy
  1. C. Plasencia1,
  2. G. Wolbink2,
  3. E. Kneepkens2,
  4. C. Krieckaert2,
  5. M. l'Ami2,
  6. D. Peiteado1,
  7. L. Nuno3,
  8. F. Arribas3,
  9. M. Nurmohamed2,
  10. E. Martín-Mola1,
  11. A. Balsa1,
  12. D. Pascual-Salcedo1
  1. 1Rheumatology, La Paz University Hospital, Madrid, Spain
  2. 2Rheumatology, Jan Van Breemen Research Institute, Reade, Amsterdam, Netherlands
  3. 3Immunology, La Paz University Hospital, Madrid, Spain

Abstract

Background There is limited evidence regarding longterm effects of tapering of TNF inhibitors (TNFi) in Spondyloarthritis (SpA) patients

Objectives To compare longterm clinical outcomes in SpA patients on tapering strategy with SpA patients on standard regimen

Methods In this observational study, 117 SpA patients (pts) treated with TNFi [infliximab (Ifx), adalimumab (Ada) and etanercept (Etn)] were included. Two groups were compared: TNFi tapering strategy (Group 1: 74 pts from Spain) vs the control group on standard treatment regimen (Group 2: 43 pts from the Netherlands). A control group for the Ifx was not available. Pts were matched on duration of inactive disease prior to inclusion and duration of followup. All SpA pts had to be at least 6 months in inactive disease (BASDAI<4) to be included. The tapering strategy included dose reduction and/or interval prolongation, in case a flare (BASDAI>4)appeared, the TNFi dose could be increased or the interval could be shortenned to regain low disease activity. The clinical activity was measured, using BASDAI, at different time points: visit-0 (baseline, prior starting the biological therapy), visit-1 (Group1: just before starting tapering; Group 2: after at least 6 months in inactive disease) and visit-2 (the last visit available after visit-1)

Results Seventy four pts were included in tapering group (Group 1: 35 with Ifx, 17 with Ada and 22 with Etn) and 43 pts in control group (Group 2: 21 with Ada and 22 with Etn). No statistical differences were seen in the time (years) in inactive disease prior visit-1 (1.23±1.09 in Group 1 vs 0.73±0.18 in Group 2, p=0.243) and followup (years) between visit-1and visit-2 (2.33±1.12 in Group 1 vs 2.40±0.99 in Group 2, p=0.567).No significant differences were found in clinical activity and percentage of pts with flares (see Table 1). The dropout tended to be higher in pts on tapering, being the secondary inefficacy more frequent in this group, but also the remission (see Table 1).The overall drug administered was reduced in tapering group at visit-2 in comparison with the group on standard protocol (dose reduction of 22% in Ifx and an elongation in administration interval of 28.7% in Ifx, 45.2% in Ada and 51.5% in Etn)

Table 1

Conclusions The tapering strategy in inactive SpA pts results in an important reduction of the drug administered while the disease control remains similar to SpA on standard regimen. However, a small percentage of SpA pts on tapering seems to be more prone to dropout due to secondary inefficacy and also the remission was more often

Disclosure of Interest C. Plasencia Grant/research support: Pfizer, G. Wolbink Grant/research support: Pfizer, Speakers bureau: Pfizer, Amgen, E. Kneepkens: None declared, C. Krieckaert Speakers bureau: Abbvie, Pfizer, M. l'Ami: None declared, D. Peiteado: None declared, L. Nuno: None declared, F. Arribas: None declared, M. Nurmohamed Grant/research support: Abbvie, BMS, MSD, Pfizer, UCB, Roche, Consultant for: Abbott, BMS, Pfizer, Roche, Speakers bureau: Abbvie, Pfizer, Roche, E. Martín-Mola Speakers bureau: Pfizer, Abbvie, Roche, UCB, A. Balsa Grant/research support: Pfizer, Speakers bureau: Pfizer, Abbvie, Roche, D. Pascual-Salcedo Grant/research support: Pfizer, Speakers bureau: Pfizer

DOI 10.1136/annrheumdis-2014-eular.3208

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