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Is tapering or discontinuation of biologic treatment in patients with radiographic and nonradiographic axial spondyloarthritis reasonable?

A local cohort study

Ist das Ausschleichen oder Absetzen einer Therapie mit Biologika bei Patienten mit radiologischer und nichtradiologischer Spondylarthritis sinnvoll?

Eine lokale Kohortenstudie

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Abstract

Objective

We retrospectively determined factors predicting biologic treatment discontinuation or tapering in patients with axSpA.

Materials and methods

We included 63 nonradiographic axSpA (nr-axSpA) and 138 radiographic axSpA (r-axSpA) patients on biologic treatments for at least 1 year. The biologic dosing intervals were increased in patients who had been in remission for at least 6 months. In patients whose biologic dosing intervals could be increased by 100% for at least 6 months, the agents were stopped at the end of that time. In patients for whom the biologic agents were stopped or tapered, relapse was defined as a Bath Ankylosing Spondylitis Disease activity index score > 4 and a CRP level > 10 mg/L.

Results

The median duration of biologic treatment (all patients) was 2 (1–11) years. Logistic regression analysis did not identify any independent predictor of treatment discontinuation. NSAID use was the only independent predictor of tapering (p = 0.001). The time to relapse after tapering was shorter in patients with r‑axSpA than nr-axSpA (25.97 vs. 39.53 months; p = 0.05). The time to relapse in patients with r‑axSpA was considerably shorter than that in patients with nr-axSpA (5.14 vs. 13 months; p = 0.001). All r‑axSpA patients relapsed over the follow-up period; only 2 nr-axSpA patients did not relapse.

Conclusion

The most significant independent predictor of relapse was NSAID use during treatment. For axSpA patients in remission, tapering of the biologic dosing intervals is more appropriate than discontinuation.

Zusammenfassung

Ziel

Retrospektiv wurden Faktoren untersucht, welche das Absetzen oder Ausschleichen einer Therapie mit Biologika bei Patienten mit axialer Spondylarthritis (axSpA) vorhersagten.

Material und Methoden

Es wurden 63 Patienten mit nichtradiologischer axSpA (nr-axSpA) und 138 mit radiologischer axSpA (r-axSpA) in die Studie einbezogen, welche seit mindestens einem Jahr unter Therapie mit Biologika standen. Die Dosierungsabstände der Biologika wurden bei Patienten, die seit wenigstens 6 Monaten in Remission waren, erhöht. Bei Patienten, deren Dosierungsabstände der Biologika um 100% für mindestens 6 Monate erhöht werden konnten, wurden die Präparate am Ende dieses Zeitraums abgesetzt. Für die Patienten, bei denen die Biologikatherapie abgesetzt oder ausgeschlichen worden war, wurde ein Rezidiv definiert als ein Wert > 4 im Bath Ankylosing Spondylitis Disease Activity Index und ein Spiegel > 10 mg/l für C‑reaktives Protein (CRP).

Ergebnisse

Die mediane Dauer der Biologikabehandlung (für sämtliche Patienten) betrug 2 (1–11) Jahre. Mit der logistischen Regressionsanalyse wurde kein unabhängiger Prädiktor für die Therapiebeendigung identifiziert. Der Gebrauch von nichtsteroidalen Antirheumatika (NSAID) war der einzige unabhängige Prädiktor für das Ausschleichen (p = 0,001). Die Dauer bis zum Rezidiv nach Ausschleichen war bei Patienten mit r‑axSpA kürzer als bei Patienten mit nr-axSpA (25,97 vs. 39,53 Monate; p = 0,05). Die Dauer bis zum Rezidiv bei Patienten mit r‑axSpA war deutlich kürzer als bei Patienten mit nr-axSpA (5,14 vs. 13 Monate; p = 0,001). Bei allen r‑axSpA-Patienten kam es im Laufe der Nachbeobachtungsphase zum Rezidiv; nur 2 nr-axSpA-Patienten blieben rezidivfrei.

Schlussfolgerung

Der wichtigste unabhängige Prädiktor für ein Rezidiv war der Gebrauch von NSAID (nonsteroidal anti-inflammatory drugs) während der Behandlung. Für axSpA-Patienten in Remission ist hinsichtlich der Dosierungsabstände der Biologika das Ausschleichen besser geeignet als das Absetzen.

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Authors and Affiliations

  1. Kanuni Sultan Süleyman Education and Research Hospital, Department of Pysical Medicine and Rehabilitation, Division of Rheumatology, University of Health Sciences, İstanbul, Turkey

    Halil Harman

  2. Department of Rheumatology, Çanakkale Mehmet Akif Ersoy State Hospital, Çanakkale, Turkey

    Nedim Kaban

Authors
  1. Halil Harman
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  2. Nedim Kaban
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Correspondence to Halil Harman.

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H. Harman and N. Kaban declare that they have no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies mentioned were in accordance with the ethical standards indicated in each case.

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Ulf Müller-Ladner, Bad Nauheim

Uwe Lange, Bad Nauheim

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Harman, H., Kaban, N. Is tapering or discontinuation of biologic treatment in patients with radiographic and nonradiographic axial spondyloarthritis reasonable?. Z Rheumatol 83 (Suppl 1), 55–61 (2024). https://doi.org/10.1007/s00393-022-01226-0

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