Objectives In a 2-year follow-up study of patients with axial spondyloarthritis (axSpA) in clinical remission who tapered TNF inhibitor (TNFi) treatment according to a clinical guideline, we aimed to investigate the proportion who successfully tapered/discontinued therapy and baseline predictors thereof. The proportion regaining clinical remission after flare and the progression on MRI/radiography were also assessed. Methods One-hundred-and-nine patients (78 [72%]/31 [28%] receiving standard and reduced dose, respectively) in clinical remission (BASDAI < 40, physician global score < 40) and no signs of disease activity the previous year tapered TNFi as follows: to two-thirds of standard dose at baseline, half at week 16, one-third at week 32 and discontinuation at week 48. Patients experiencing clinical, BASDAI or MRI flare (predefined criteria) stopped tapering and escalated to previous dose. Prediction analyses were performed by multivariable regression. Results One hundred and six patients (97%) completed 2 years’ follow-up; 55 patients (52%) had successfully tapered: 23 (22%) receiving two-thirds, 15 (14%) half, 16 (15%) one-third dose and 1 (1%) discontinued. In patients at standard dose at baseline (n = 78), lower physician global score was the only independent predictor of successful tapering (odds ratio [OR] = 0.79 [95% CI: 0.64, 0.93]; P = 0.003). In the entire patient group lower physician global score (OR = 0.86 [0.75, 0.98]; P = 0.017), lower Spondyloarthritis Research Consortium of Canada (SPARCC) Sacroiliac Joint Erosion score (OR = 0.78 [0.57, 0.98]; P = 0.029) and current smoker (OR = 3.28 [1.15, 10.57]; P = 0.026) were independent predictors of successful tapering. At 2 years, 97% of patients were in clinical remission. Minimal changes in imaging findings were observed. Conclusion After 2 years following a clinical guideline, 52% of patients with axSpA in clinical remission had successfully tapered TNFi, only 1% discontinued. Baseline physician global score was an independent predictor of successful tapering.

中文翻译：

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常规护理中中轴型脊柱关节炎中 TNF 抑制剂的逐渐减量——2 年临床和 MRI 结果以及成功减量的预测因素

目的 在一项为期 2 年的随访研究中，对临床缓解的轴型脊柱关节炎 (axSpA) 患者根据临床指南逐渐减少 TNF 抑制剂 (TNFi) 治疗，我们旨在调查成功减少/停止治疗的比例和基线预测因素其中。还评估了发作后恢复临床缓解的比例和 MRI/X 线摄影的进展。方法 109 名患者（分别为 78 [72%]/31 [28%] 接受标准剂量和减少剂量）临床缓解（BASDAI < 40，医师整体评分 < 40）且没有疾病迹象前一年的活动逐渐减少 TNFi 如下：基线时标准剂量的三分之二，第 16 周时减半，第 32 周时减半，第 48 周时停药。BASDAI 或 MRI 耀斑（预定义标准）停止逐渐减量并升级到之前的剂量。通过多变量回归进行预测分析。结果 106例患者（97%）完成了2年的随访；55 名患者 (52%) 成功减量：23 名 (22%) 接受三分之二、15 名 (14%) 一半、16 名 (15%) 三分之一剂量和 1 名 (1%) 停药。在基线标准剂量的患者（n = 78）中，较低的医师整体评分是成功减量的唯一独立预测因子（优势比 [OR] = 0.79 [95% CI: 0.64, 0.93]；P = 0.003）。在整个患者组中，医师整体评分较低（OR = 0.86 [0.75, 0.98]；P = 0.017），加拿大脊柱关节炎研究联盟 (SPARCC) 骶髂关节侵蚀评分较低（OR = 0.78 [0.57, 0.98]；P = 0.029 ) 和当前吸烟者 (OR = 3.28 [1.15, 10.57]; P = 0。026）是成功减量的独立预测因素。2 年时，97% 的患者达到临床缓解。观察到成像结果的最小变化。结论 遵循临床指南 2 年后，临床缓解的 52% 的 axSpA 患者成功减量 TNFi，只有 1% 停止使用。基线医师整体评分是成功减量的独立预测因子。