SAT0262 3-year follow-up of a dose tapering protocol of anti-tnf therapy in a cohort of patients with spondyloarthritis (SPA) in clinical remission under conditions of clinical practice

Abstract

Background: The dose tapering of biological therapy in patients in clinical remission is a strategy used in recent years in Rheumatology, consists in the reduction of the dose administered or in the extension of the interval between two doses, some studies suggest the possibility that patients with sustained remission could obtain the same benefit with a lower dose. Objectives: Evaluate the effectiveness of 3 year follow-up of a dose tapering in patients with SpA in maintained clinical remission and detect possible predictors of maintenance of the response. Methods: Retrospective observational study, all patients with SpA were included, according to ASAS criteria, treated with antiTNF, with dose tapering, from October 2014-December 2017. Clinical remission defined by BASDAI ≤2 and/or CRP ≤5 mg/L for at least 6 months, establishing dose tapering as lower doses or longer intervals(according to the guidelines of the Spanish Society of Rheumatology and Pharmacy). Those patients who relapsed (BASDAI >2 and/or CRP >5 mg/L) at any time during the study returned to the standard dose. Clinical and analytical parameters were collected (baseline and at the time of optimisation), as well as the survival of the drug and the efficacy parameters until the time of relapse and who continued in dose tapering. Results: 149 patients with SpA in treatment with antiTNF, 38/149 (25.5%) included in the dose tapering protocol, 84.4% men and the mean age 47.2±10.6 years. The antecedents 25% uveitis, 6.3% psoriasis and 6.3% inflammatory bowel disease. Regarding the type of optimisation strategy, 32 patients (84.37%) followed the protocol for increasing the interval between doses, compared to the rest (15.62%) who used reduced doses. We found 27/38 patients (71.05%, CI: 55.2-83) maintained clinical remission with tapering, 9 (33.3%) infliximab, 7 (25.9%) golimumab, 6 (22.2%) etanercept and 5 (18.5%) adalimumab, at a time of drug follow-up of 57.9±29.7 months. The demographic factors analysed sex, age, time of evolution and clinical remission, were not found as possible predictors of greater survival in the dose tapering (Table Presented) Conclusions: The monitoring of dose tapering of biological therapy in patients with SpA is possible and allows more than 70% of patients to maintain the clinical remission of the disease. However, a greater number of patients and longer follow-up are necessary for a solid conclusion. Additionally, our results do not show possible predictors of a longer survival in tapering protocol.