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• Correspondence on “Recapture and retreatment rates with ixekizumab after withdrawal of therapy in patients with axial spondyloarthritis: results at week 104 from a randomised placebo-controlled withdrawal study”
  Alireza Sadeghi
  Published on: 23 January 2023

• Published on: 23 January 2023

  Correspondence on “Recapture and retreatment rates with ixekizumab after withdrawal of therapy in patients with axial spondyloarthritis: results at week 104 from a randomised placebo-controlled withdrawal study”

  • Alireza Sadeghi, Student Research Committee Shiraz University of Medical Sciences

  Title: Correspondence on “Recapture and retreatment rates with ixekizumab after withdrawal of therapy in patients with axial spondyloarthritis: results at week 104 from a randomised placebo-controlled withdrawal study”
  To the Editor
  I recently have read with great interest the research paper written by Dr. Landewé et al. entitled “Recapture and retreatment rates with ixekizumab after withdrawal of therapy in patients with axial spondyloarthritis: results at week 104 from a randomised placebo-controlled withdrawal study” published recently in Annals of the Rheumatic Diseases (1). In this study, patients with axial spondyloarthritis in remission who were on ixekizumab were randomised to either continue the treatment or withdraw to placebo. The study compared the rate of occurrence of flare between these two arms and assessed the efficacy of readministration of ixekizumab. This study provided strong evidence regarding treatment discontinuation with ixekizumab in patients with axial spondyloarthritis with a well-developed design and proper sample size; however, there are some points that should be more discussed in the article.
  In the limitation, the authors have reported that they did not use Ankylosing Spondylitis Disease Activity Score (ASDAS) to define whether a patient had a flare or not; however, in the methods section of this article and their previously published article (2) and also in the protocol of COAST-Y (NCT03129100), this composite index, ASDA...

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  Title: Correspondence on “Recapture and retreatment rates with ixekizumab after withdrawal of therapy in patients with axial spondyloarthritis: results at week 104 from a randomised placebo-controlled withdrawal study”
  To the Editor
  I recently have read with great interest the research paper written by Dr. Landewé et al. entitled “Recapture and retreatment rates with ixekizumab after withdrawal of therapy in patients with axial spondyloarthritis: results at week 104 from a randomised placebo-controlled withdrawal study” published recently in Annals of the Rheumatic Diseases (1). In this study, patients with axial spondyloarthritis in remission who were on ixekizumab were randomised to either continue the treatment or withdraw to placebo. The study compared the rate of occurrence of flare between these two arms and assessed the efficacy of readministration of ixekizumab. This study provided strong evidence regarding treatment discontinuation with ixekizumab in patients with axial spondyloarthritis with a well-developed design and proper sample size; however, there are some points that should be more discussed in the article.
  In the limitation, the authors have reported that they did not use Ankylosing Spondylitis Disease Activity Score (ASDAS) to define whether a patient had a flare or not; however, in the methods section of this article and their previously published article (2) and also in the protocol of COAST-Y (NCT03129100), this composite index, ASDAS, was mentioned to be considered and utilized for definition of flare. By the way, if this index was not used, the authors should discuss about the tool they used completely in the methods. Second, the authors mentioned that some of the patients had ASDAS of 2.1 at two consecutive visits but they did not have a flare. The article lacks information regarding the number of these patients and their clinical and laboratory features. Addition of this information to the work could increase its credibility and would remove any potential bias of selective reporting. Third, the method of active treatment discontinuation used in this study was not valid and ixekizumab was not tapered. Dr. Navarro-Compán and colleagues conducted a systematic review to assess the disease status of patients with axial spondyloarthritis following discontinuation or tapering strategies of tumor necrosis factor inhibitors (3). They suggested that the rate of flare would be higher in those with a discontinuation strategy. Therefore, for such studies like this study that the experience of a flare is the primary outcome, the method of withdrawal of the medication could be consequential, especially when this method was only applied to one arm of the study and could be considered as a source for confounding. The authors should at least justify the reason why they did not follow the recommendations of withdrawal.
  Acknowledgement: None.
  Conflict of Interest statement: Authors declare no conflict of interests.
  Funding: None.
  References
  1. Landewé RBM, Poddubnyy D, Rahman P, Van den Bosch FE, Bolce R, Liu Leage S, et al. Recapture and retreatment rates with ixekizumab after withdrawal of therapy in patients with axial spondyloarthritis: results at week 104 from a randomised placebo-controlled withdrawal study. Annals of the Rheumatic Diseases. 2022:annrheumdis-2022-222731.
  2. Landewé RBM, Gensler LS, Poddubnyy D, Rahman P, Hojnik M, Li X, et al. Continuing versus withdrawing ixekizumab treatment in patients with axial spondyloarthritis who achieved remission: efficacy and safety results from a placebo-controlled, randomised withdrawal study (COAST-Y). Annals of the Rheumatic Diseases. 2021;80(8):1022.
  3. Navarro-Compán V, Plasencia-Rodríguez C, de Miguel E, Balsa A, Martín-Mola E, Seoane-Mato D, et al. Anti-TNF discontinuation and tapering strategies in patients with axial spondyloarthritis: a systematic literature review. Rheumatology. 2016;55(7):1188-94.

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  Conflict of Interest:
  None declared.

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