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Tumour necrosis factor inhibitor tapering in patients with ankylosing spondylitis at low disease activity: factors associated with flare

Authors
 Oh Chan Kwon  ;  Jung Hwan Park  ;  Min-Chan Park 
Citation
 THERAPEUTIC ADVANCES IN MUSCULOSKELETAL DISEASE, Vol.13 : 1759720X20986732, 2021-01 
Journal Title
 THERAPEUTIC ADVANCES IN MUSCULOSKELETAL DISEASE 
ISSN
 1759-720X 
Issue Date
2021-01
Keywords
ankylosing spondylitis ; dose tapering ; flare ; tumour necrosis factor inhibitor
Abstract
Background: To investigate factors associated with flare in patients with ankylosing spondylitis (AS) who tapered tumour necrosis factor inhibitors (TNFis) after achievement of low disease activity (LDA) with the standard dose of TNFis. Methods: This retrospective cohort study included 101 patients with AS who tapered their first TNFis after achievement of LDA. The proportion of reduced versus standard doses of TNFi throughout the follow up in each patient was quantified using the time-averaged dose quotient (DQ). Clinical characteristics were compared between patients who did and did not experience flare after TNFi tapering. Multivariable Cox regression analysis was performed to identify factors associated with flare. Receiver operating characteristic curve analysis was performed to determine the cut-offs of these covariates that best predicted flare. Results: Of the total 101 patients, 45 (44.6%) patients experienced flare after TNFi tapering. Compared with patients who did not experience flare, those who experienced flare had a shorter disease duration (p = 0.006), shorter LDA duration before TNFi tapering (p < 0.001) and lower time-averaged DQ (p < 0.001). In multivariable Cox regression analysis, the LDA duration [adjusted hazard ratio (HR): 0.944, 95% confidence interval (CI): 0.906-0.983, p = 0.006] and time-averaged DQ (adjusted HR: 0.978, 95% CI: 0.959-0.998, p = 0.032) were inversely associated with flare. The cut-off values of the LDA duration and time-averaged DQ that best predicted flares were <5.3 months and <60.6%, respectively. Conclusion: Shorter LDA duration (cut-off value: 5.3 months) and lower time-averaged DQ (cut-off value: 60.6%) were associated with a higher risk of flare after tapering TNFi.
Files in This Item:
T202100273.pdf Download
DOI
10.1177/1759720X20986732
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kwon, Oh Chan(권오찬)
Park, Min Chan(박민찬) ORCID logo https://orcid.org/0000-0003-1189-7637
Park, Jung Hwan(박정환)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/182041
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