medwireNews: Temporary discontinuation of etanercept could be an option for around a quarter of patients with nonradiographic axial spondyloarthritis (axSpA) who achieve stable inactive disease, delegates were told at the EULAR 2020 E-Congress.
Presenter Filip Van den Bosch (Ghent University Hospital, Belgium) explained that “current treatment guidelines do not agree on whether a [tumor necrosis factor]-blocking agent or other biologic DMARDs should be tapered once a status of low disease activity or remission is achieved.”
Together with colleagues, he conducted the phase 4 RE-EMBARK trial, which involved three periods. During period 1, a total of 208 patients with nonradiographic axSpA received open-label, subcutaneous etanercept 50 mg/week in addition to background nonsteroidal anti-inflammatory drugs (NSAIDs) for 24 weeks.
At the end of this period, 122 (59%) patients achieved inactive disease, defined as an ASDAS-CRP score below 1.3, and 119 of these patients proceeded to period 2. This comprised 40 weeks of withdrawal where the patients discontinued etanercept but maintained their background NSAIDs.
During this withdrawal period, the proportion of patients experiencing disease flare, as determined by an ASDAS-ESR score of 2.1 or higher, increased from 22% at week 4 to 67% at week 40.
And Van den Bosch reported that 50% of patients experienced disease flare within 16.1 weeks. This compared with less than 25% of patients in the EMBARK trial who continued to take etanercept for 40 weeks.
Nevertheless, Van den Bosch highlighted that 24% of patients in period 2 maintained an inactive disease state over the entire 40 weeks, 50% maintained an ASDAS-ESR score of lower than 2.1 for 16 weeks or longer, and among those who flared, 62% had regained an inactive disease state within 12 weeks of re-treatment with etanercept 50 mg/week in period 3.
He therefore concluded: “Temporarily discontinuing etanercept may be an option for some patients with stable, inactive non-radiographic axSpA.”
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EULAR 2020 E-Congress; 3–6 June
Ann Rheum Dis 2020; doi:10.1136/annrheumdis-2020-eular.1322