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Effects of tapering tumor necrosis factor inhibitor on the achievement of inactive disease in patients with axial spondyloarthritis: a nationwide cohort study

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dc.contributor.authorPark, Jun Won-
dc.contributor.authorKim, Hyoun-Ah-
dc.contributor.authorShin, Kichul-
dc.contributor.authorPark, Yong-Beom-
dc.contributor.authorKim, Tae-Hwan-
dc.contributor.authorSong, Yeong Wook-
dc.contributor.authorLee, Eun Young-
dc.date.accessioned2019-07-09T08:14:31Z-
dc.date.available2019-07-09T17:15:03Z-
dc.date.issued2019-07-04-
dc.identifier.citationArthritis Research & Therapy. 2019 Jul 04;21(1):163ko_KR
dc.identifier.issn1478-6362-
dc.identifier.urihttp://hdl.handle.net/10371/156818-
dc.description.abstractObjectives
To investigate the association between the extent of tapering tumor necrosis factor inhibitor (TNFi) and the likelihood of achieving inactive disease in patients with axial spondyloarthritis (axSpA)

Methods
We analyzed 1575 1-year follow-up interval data of 776 axSpA patients treated with TNFi for more than 1 year in a nationwide observational cohort. The decision on tapering TNFi was made by patients and their physicians. We quantified TNFi used during interval as a dose quotient (DQ). The intervals were classified into the heavy-tapering (DQ < 50), mild-tapering (DQ 50–99), and control groups (DQ = 100). Outcome variables included achieving Ankylosing Spondylitis Disease Activity Score-inactive disease (ASDAS-ID) and major clinical response of Bath Ankylosing Spondylitis Disease Activity Index (BASDAI50) in the follow-up visit. The effects of TNFi tapering on the outcome were analyzed using the generalized estimating equation.

Results
At the baseline visit, 91.1% of the patients showed a high disease activity (ASDAS-CRP ≥ 2.1). DQ of each interval was significantly influenced by the ASDAS-CRP measure in the prior follow-up (P < 0.001). ASDAS-ID was observed in 42.3% of the intervals. A multivariable analysis showed that the likelihood of outcome achievement was comparable between the control and mild-tapering groups, but significantly decreased in the heavy-tapering group (vs. the control group, adjusted OR = 0.28, [95% CI, 0.08–0.94]). In contrast, the likelihood to achieve BASDAI50 response was not different among the groups. In the subgroup of patients who reached ASDAS-ID 1 year after TNFi treatment (n = 327), ASDAS-ID was observed in 66.1% of the subsequent intervals, and only the mild-tapering group showed a likelihood of target maintenance comparable with that of the control group (adjusted OR = 1.25 [0.41–3.80]). This likelihood decreased with an increase in ASDAS-CRP.

Conclusion
Mild tapering of TNFi has efficacy comparable with that of the standard-dose treatment for ASDAS-ID achievement in patients with axSpA.
ko_KR
dc.description.sponsorshipThis study was supported by the Korea Health Technology R & D Project through the Korea Health Industry Development Institute funded by the Ministry of Health Welfare, Republic of Korea (grant HI14C1277)ko_KR
dc.language.isoenko_KR
dc.publisherBioMed Centralko_KR
dc.subjectSpondyloarthritisko_KR
dc.subjectTumor necrosis factorko_KR
dc.subjectDose taperingko_KR
dc.subjectInactive diseaseko_KR
dc.titleEffects of tapering tumor necrosis factor inhibitor on the achievement of inactive disease in patients with axial spondyloarthritis: a nationwide cohort studyko_KR
dc.typeArticleko_KR
dc.contributor.AlternativeAuthor박준원-
dc.contributor.AlternativeAuthor김현아-
dc.contributor.AlternativeAuthor신기철-
dc.contributor.AlternativeAuthor박용범-
dc.contributor.AlternativeAuthor김태환-
dc.contributor.AlternativeAuthor송영욱-
dc.contributor.AlternativeAuthor이은영-
dc.identifier.doi10.1186/s13075-019-1943-6-
dc.language.rfc3066en-
dc.rights.holderThe Author(s).-
dc.date.updated2019-07-07T03:40:12Z-
Appears in Collections:
College of Medicine/School of Medicine (의과대학/대학원)Internal Medicine (내과학전공)Journal Papers (저널논문_내과학전공)
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