Treat-to-Target Tapering of TNFi Studied for Noninferiority in PsA, axSpA

Treat-to-target tapering of tumor necrosis factor inhibitors (TNFi) was noninferior to a treat-to-target strategy without tapering among patients with psoriatic arthritis and axial spondyloarthritis, according to a study published in the Annals of the Rheumatic Diseases.

“TNFi are effective in psoriatic arthritis and axial spondyloarthritis, but are associated with a small (0.6%) increase in serious infection risk, patient burden due to need for self-injection, and high costs,” wrote a research team from the Netherlands. “Treat-to-target tapering might ameliorate these drawbacks, but high-quality evidence on treat-to-target tapering strategies is lacking in psoriatic arthritis and axial spondyloarthritis.”

The single-center, open-label noninferiority trial included 122 patients, of whom 64 had psoriatic arthritis and 58 had axial spondyloarthritis, with stable to low disease activity for at least 6 months. Some 81 patients were randomized to a treat-to-target approach with tapering and 41 patients to treat-to-target without tapering.

At a 12-month follow-up, low disease activity was sustained by 73% in the no-tapering group compared with 69% in the tapering group, according to the study. Researchers reported an adjusted difference of 5%, which confirmed noninferiority of tapering per a prespecified margin of 20%.

The average percentage of daily defined dose at month 12 was 91% for the no-tapering group and 53% for the tapering group, the study found.

“A treat-to-target TNFi strategy with tapering attempt is noninferior to a treat-to-target strategy without tapering with regard to the proportion of patients still in low disease activity at 12 months,” researchers wrote, “and results in a substantial reduction of TNFi use.”

—Jolynn Tumolo

Reference

Michielsens CA, den Broeder N, van den Hoogen FH, et al. Treat-to-target dose reduction and withdrawal strategy of TNF inhibitors in psoriatic arthritis and axial spondyloarthritis: a randomised controlled non-inferiority trial. Ann Rheum Dis. 2022;81(10):1392-1399. doi.org/10.1136/annrheumdis-2022-222260