Structural Lesion Progression of the Sacroiliac Joint and Clinical Features in axSpA During TNFi Reduction: A Retrospective Cohort Study.

Qian Mo,Jixin Zhong,Cong Ye,Min Wang,Lingli Dong,Shaozhe Cai,Yuanji Dong

doi:10.3389/fmed.2021.781088

Qian Mo, Jixin Zhong + Show 5 more

Open Access

https://doi.org/10.3389/fmed.2021.781088

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Abstract

Objective: In the clinic, some patients with axial spondyloarthritis (axSpA) have to reduce tumor necrosis factor inhibitor (TNFi) for various reasons. However, there are few studies about how to balance the relapse and TNFi reduction. Here we retrospectively analyzed the structural progression of the sacroiliac joint (SIJ) and clinical features in axSpA during TNFi reduction.Methods: A total of 108 patients with axSpA who followed up for 2 years and completed at least baseline, 12-month, and 24-month MRI scans of SIJ were divided into the tapering group (n = 63) and withdrawal group (n = 45) according to whether TNFi was stopped. We divided 2 years into five intervals, calculating the average dose quotient (DQ) for each of 540 intervals from 108 patients. By using generalized estimation equations with inverse probability of treatment weighting, we investigated the unbiased effects of average DQ on structural progression and treatment response.Results: The disease activity (such as Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Ankylosing Spondylitis Disease Activity Score (ASDAS)-CRP, and ASDAS-ESR) and relapse rate were lower in the tapering group at 12 and 24 months (p < 0.05). Δerosion (β = −0.0100, p = 0.00026) and Δthe Spondyloarthritis Research Consortium of Canada (SPARCC; β = −0.0959, p < 0.0001) were negatively correlated with average DQ. The average DQ 30 (74.8%, 80.0%) or 41.6 (76.5%, 83%) was best to discriminate the status of treatment response or the status of bone marrow edema, but considering operability, the average DQ 25 (78.0%, 63.3%) was also acceptable especially for patients with HLA-B27 negative and non-severe fat metaplasia.Conclusion: Complete TNFi withdrawal was not recommended. Our study provided a referable strategy (tapering then maintained the average DQ over 30 or even 25) for patients who need TNFi reduction. Higher dose usage of TNFi was associated with a slower erosion progression of SIJ.

Highlights

Axial spondyloarthritis is a chronic inflammatory disease that mainly affects the spine and sacroiliac joints (SIJ) [1,2,3]
In the real world, it is inescapable that some patients have to opt for dose reduction or withdrawal because of intolerance to full-standard tumor necrosis factor inhibitor (TNFi), risk of potential infection, unaffordability to high expense, intolerability for long-term subcutaneous injection, or multiple reasons [22, 23], while complete withdrawal often leads to relapse [24, 25]
We further explored whether the response of patients with ankylosing spondylitis (AS) and non-axSpA to the TNFi reduction treatment was similar in each group

Summary

Introduction

Axial spondyloarthritis (axSpA) is a chronic inflammatory disease that mainly affects the spine and sacroiliac joints (SIJ) [1,2,3]. Several studies have begun to use tapering strategy for patients with axSpA and have shown that tapering TNFi to the extent of 75% and 50% full dose has comparable efficacy in maintaining low disease activity [26,27,28,29,30,31,32]. Previous studies mainly focused on the radiographic changes of the spine, while the impact of tapering TNFi on structural lesion progression of the SIJ was rarely studied.

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Conclusion