TOPLINE

A treat-to-target tapering strategy for TNF inhibitors appeared to maintain low disease activity for up to 2 years in patients with psoriatic arthritis and axial spondyloarthritis.

METHODOLOGY

• This 12-month observational extension of the DRESS-PS trial included 114 patients with psoriatic arthritis or axial spondyloarthritis who had stable low disease activity for at least 6 months.
• Patients were originally randomly assigned to either a treat-to-target tapering strategy (the intervention group), which involved extending the interval between TNF inhibitor doses, or a treat-to-target strategy without tapering (the control group); 79 patients were from the original intervention group and 35 were from the original control group.
• During the extension phase, patients in the control group were allowed to attempt treat-to-target tapering.
• The primary outcome was the difference between the original intervention and control groups in the proportion of patients with low disease activity at 24 months, compared with a prespecified noninferiority margin of 20%.
• Low disease activity was defined as the absence of extra-articular symptoms combined with either a Psoriatic Arthritis Disease Activity Score of 3.2 or lower and body surface area involvement of 3% or less for psoriatic arthritis or an Axial Spondyloarthritis Disease Activity Score of 2.1 or lower for axial spondyloarthritis.

TAKEAWAY

• At 24 months, 67% of patients in the intervention group and 72% of those in the control group maintained low disease activity, with an adjusted difference of 5% (95% CI, -15% to 24%; P = .64); with the imputation of missing data, the adjusted difference was 2% (95% CI, -18% to 16%; P = .85), which fell within the noninferiority margin.
• The cumulative incidence of disease flares over 24 months was 92% in the intervention group and 86% in the control group.
• The mean TNF inhibitor daily dose as a percentage of defined daily dose at 24 months was 66% in the intervention group vs 77% in the control group (difference, 11%; P = .14); 56% of patients in the intervention group and 43% of those in the control group were on a reduced TNF inhibitor dose or had discontinued use at 24 months compared with baseline.
• At least one adverse event occurred in 99% of patients in the intervention group and 89% of those in the control group over the 24-month period; no significant differences in infections or injection site reactions were observed between the two groups.

IN PRACTICE

"[T]hese data indicate that a taper-to-target strategy is effective and leads to substantial TNF inhibitor dose reduction, but optimal execution of such a strategy in routine care is more challenging than in the context of a clinical trial," the authors of the study wrote.

SOURCE

The study was led by Amy C.D. Peeters, MD, Sint Maartenskliniek in Ubbergen, Netherlands. It was published online on July 24 in The Lancet Rheumatology.

LIMITATIONS

Disease activity measurements at 18 and 24 months were missing. Validated flare criteria for disease flare in axial spondyloarthritis were absent. Radiographic progression was not assessed at 24 months. Tapering was allowed in the control group during the extension phase, which may have reduced the difference between groups.

DISCLOSURES

The study was supported by ReumaNederland. Some authors reported receiving grants to their institution and/or support for attending meetings from pharmaceutical companies, unrelated to this work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.