Is tapering or discontinuation of biologic treatment in patients with radiographic and nonradiographic axial spondyloarthritis reasonable? : Alocal cohort study.

Abstract

We retrospectively determined factors predicting biologic treatment discontinuation or tapering in patients with axSpA. We included 63nonradiographic axSpA (nr-axSpA) and 138 radiographic axSpA (r-axSpA) patients on biologic treatments for at least 1year. The biologic dosing intervals were increased in patients who had been in remission for at least 6months. In patients whose biologic dosing intervals could be increased by 100% for at least 6months, 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 aBath Ankylosing Spondylitis Disease activity index score > 4 and aCRP level > 10 mg/L. The median duration of biologic treatment (all patients) was2 (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. 39.53months; 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. 13months; p = 0.001). All r‑axSpA patients relapsed over the follow-up period; only 2nr-axSpA patients did not relapse. 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.