Meta-analysis data do not support TNF inhibitor dose reduction in axSpA
medwireNews: Reducing tumor necrosis factor (TNF) inhibitor dose below the standard level does not appear to benefit patients with axial spondyloarthritis (axSpA), shows a meta-analysis of randomized controlled trials (RCTs).
“Our findings confirm previous studies where standard TNF [inhibitor] doses suggest some benefit for disease activity and are more efficacious for achieving and maintaining stable disease, Daeria Lawson (Toronto Western Hospital, Ontario, Canada) and co-authors write in Arthritis Care & Research.
Lawson and team analyzed data from six RCTs including a total of 747 individuals with axSpA (median age 39 years, median disease duration 12 years, 77% men). Of these, 442 had ankylosing spondylitis (AS) and 305 had nonradiographic axSpA (nr-axSpA).
Etanercept was the study drug in three trials, one trial each investigated infliximab and adalimumab, and for the final trial patients were treated with any of adalimumab, etanercept, golimumab, or infliximab.
The majority (n=5) of trials investigated either a lower dose or an extended dosing interval as the method of TNF inhibitor reduction, while just one studied full discontinuation.
The researchers found that dose reduction was associated with a significant 38% reduction in the likelihood of achieving an ASAS40 response and a significant 83% lower likelihood of achieving ASAS partial remission relative to the standard dose.
In addition, BASDAI score was a mean 0.35 points higher with the reduced versus standard TNF inhibitor dose, while the risk for disease flares or relapses was a significant 73% higher.
There were no significant differences between the two dose regimens in C‐reactive protein levels or in the rates of infection and other adverse events, and there was insufficient data to carry out a pooled analysis of ASDAS, or measure maintenance of remission and quality of life, the investigators note.
Lawson et al say: “From a clinical standpoint, it is unclear whether there is a strong enough clinical basis to withdraw [TNF inhibitor] therapy altogether.”
They add that further study of different TNF inhibitor dose reduction regimens in needed “to evaluate the potential for a dose response, or differences in treatment effect depending on the type of TNF [inhibitor] that is reduced.”
The authors also stress that their findings may not be generalizable to nr-axSpA because five of the six studies only included patients with AS.
“It is possible that TNF [inhibitor] dose reduction strategies may be acceptable in this group but further research is needed,” they write.
medwireNews is an independent medical news service provided by Springer Healthcare. © 2020 Springer Healthcare part of the Springer Nature group