Feasibility of TNF-Inhibitor Dose Reduction in Patients with Psoriatic Arthritis and Ankylosing Spondylitis

JULY 11, 2016
Andrew Smith
New research indicates that most psoriatic arthritis patients can maintain low disease activity on reduced doses of tumor necrosis factor inhibitors (TNFis) — but patients who experience flares after switching to the lower dose can struggle to regain control over their disease.
Investigators recruited 15 psoriatic arthritis patients whose disease activity score in 28 joints (DAS28 ESR) remained at or below 3.2 for 6 months or more and another 33 ankylosing spondylitis patients whose Bath ankylosing spondylitis disease activity index (BASDAI) had remained under 4 for the same period.
The investigators then lowered each patient’s TNFi dosage by a third. Patients who fared well continued on the lower dose indefinitely. Patients who experienced flares (defined as index scores above the threshold levels above) resumed standard TNFi doses.
Overall, 9 of the 15 psoriatic arthritis patients (60%) and 19 of the 33 ankylosing spondylitis patients (58%) remained on the lower dose for a mean period of 1 year (standard deviation, 0.8 years).
Among ankylosing spondylitis patients who experienced flares during the study period, the resumption of standard TNFi doses brought disease activity back down. After 24 weeks of treatment at the higher dose, there were no significant differences in BASDAI scores between patients who flared (mean score, 2.4; standard deviation, 1.1) and patients who maintained low disease activity on less medication (mean score, 1.9; standard deviation, 1.5; p=0.229).
The same was not true for psoriatic arthritis patients. Those who resumed normal medication doses after experiencing flares had significantly higher disease activity than those whose disease activity remained low.

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