ACR 2020 | Daily Highlights

Etanercept: withdrawal and retreatment

PREDICTORS OF MAINTAINING INACTIVE DISEASE AFTER ETANERCEPT WITHDRAWAL, AND REGAINING INACTIVE DISEASE STATUS AFTER FLARE AND RETREATMENT, IN ADULTS WITH NON-RADIOGRAPHIC AXIAL SPONDYLOARTHRITIS: RESULTS FROM RE-EMBARK

Abstract: 2028
Authors: Filip Van den Bosch et al.

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Key content:
Whether and in which patients with axSpA successfully treated with TNF inhibitors the therapy can be discontinued is a matter of debate. The RE-EMBARK study has analyzed patients with nr-axSpA treated with Etanercept (ETA). In a first period all patients were treated with ETA. Patients achieving ASDAS-CRP <1.3 at 24wk could enter period 2 with discontinuation of ETA. Patients with a flare in period 2 could enter period 3 with restart of ETA for 12 weeks. 73% of the patients entering period 2 experienced a flare within the follow up of 40 weeks. Predictors for maintaining inactive disease in period 2 were analyzed. In the multivariate regression analysis the absence of a combination of positive MRI and high sensitive CRP >3mg/l was a significant predictor of maintenance of inactive disease after discontinuation of ETA. In patients who flared and restarted ETA, male sex and age <40 was associated with regaining inactive disease.

Relevance:
The study shows that a majority of patients with inactive nr-axSpA who discontinue TNF-inhibitor therapy flare within less than one year, only 27% maintain inactive disease. Patients that are not at the same time MRI positive and have a hs-CRP of >3mg/l at baseline are significantly more likely to remain inactive and are candidates for discontinuation of TNF-inhibitor therapy.

Zusammenfassung und Kommentar von:
Prof. Dr. Diego Kyburz
Basel