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  11. Flare Prediction After Tapering The Dose Of Tumour Necrosis Factor Inhibitors In Patients With Axial Spondyloarthritis: A Nationwide Cohort Study

Flare prediction after tapering the dose of tumour necrosis factor inhibitors in patients with axial spondyloarthritis: a nationwide cohort study

Jina Yeo1, Ju Yeon Kim2, Jin Kyun Park2

  • 1Division of Rheumatology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea.

Rheumatology (Oxford, England)
|March 13, 2024

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View abstract on PubMed

Summary
This summary is machine-generated.

A new model predicts flares in axial spondyloarthritis patients after reducing tumour necrosis factor inhibitors (TNFi). This tool helps identify patients who can safely taper TNFi without experiencing disease flares.

Area of Science:

  • Rheumatology
  • Immunology
  • Clinical Prediction Modeling

Background:

  • Tumour necrosis factor inhibitors (TNFi) are effective in treating axial spondyloarthritis (axSpA).
  • Dose tapering of TNFi is a strategy to manage long-term treatment, but carries a risk of disease flares.
  • Predicting flare risk is crucial for optimizing treatment and patient selection for dose reduction.

Purpose of the Study:

  • To develop and validate a predictive model for flares following TNFi dose tapering in axSpA patients.
  • To identify key clinical parameters associated with flare risk after TNFi dose reduction.

Main Methods:

  • A derivation cohort of 526 axSpA patients who tapered TNFi after at least one year of standard-dose treatment was analyzed.
  • Flare was defined as an Ankylosing Spondylitis Disease Activity Score with C-reactive protein (ASDAS-CRP) ≥2.1 one year after tapering.
Keywords:
TNFi taperingflareprediction modelspondyloarthritis

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  • A multivariable prediction model was developed and validated in an independent cohort.

    • Main Results:

    • A flare occurred in 24.1% of patients (127/526).
    • The final model incorporated negative HLA-B27, inflammatory back pain, psoriasis, family history of SpA, diabetes mellitus, TNFi tapering amount (≥50%), baseline ASDAS-CRP, and Bath Ankylosing Spondylitis Functional Index.
    • The model demonstrated excellent discrimination (AUC=0.828) and classified patients into low (4.5% flare), intermediate (18.1% flare), and high-risk (61.8% flare) groups.

    Conclusions:

    • An accurate prediction model for TNFi tapering flares in axSpA was established using eight simple clinical parameters.
    • This model can aid clinicians in selecting appropriate patients for TNFi dose tapering, minimizing flare risk in routine practice.