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TNFi-induced sustained clinical remission in peripheral spondyloarthritis patients cannot be maintained with a step-down strategy based on methotrexate.

Authors
  • Carron, Philippe1, 2
  • De Craemer, Ann-Sophie1, 2
  • Renson, Thomas1, 2
  • Colman, Roos3
  • Elewaut, Dirk1, 2
  • Van den Bosch, Filip1, 2
  • 1 Department of Internal Medicine and Paediatrics, Ghent University Hospital.
  • 2 VIB Center for Inflammation Research.
  • 3 Biostatistics Unit of the Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium. , (Belgium)
Type
Published Article
Journal
Rheumatology (Oxford, England)
Publication Date
Oct 02, 2021
Volume
60
Issue
10
Pages
4880–4883
Identifiers
DOI: 10.1093/rheumatology/keab056
PMID: 33471112
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Treatment with golimumab monotherapy in early peripheral SpA (pSpA) results in higher rates of clinical remission compared with treatment in more longstanding disease. When reaching remission, treat-to-target recommendations suggest tapering of treatment. We therefore explored whether addition of MTX would permit discontinuation of golimumab in patients with pSpA in sustained clinical remission. After a 2-year extension phase with golimumab treatment, patients with pSpA reaching clinical remission in the CRESPA trial were offered a tapering strategy leading to discontinuation of golimumab and replacement by MTX monotherapy. Patients were prospectively followed to assess the rate of sustained biologic-free clinical remission. In case of relapse of arthritis, enthesitis or dactylitis under MTX monotherapy, golimumab was restarted. Of the original 60 pSpA patients, 25 entered the step-down strategy. Currently, only 4 patients (16%) are still in sustained remission under MTX monotherapy. In 21 patients (84%), golimumab was reinstalled because of relapse of disease activity (n = 19) or development of adverse events related to MTX (n = 2). Restarting golimumab treatment promptly restored clinical remission in all patients within 12 weeks. In patients with early pSpA achieving clinical remission after 2 years of golimumab treatment, step-down therapy to monotherapy with MTX led to high rates of clinical relapse. This underscores the overall weak efficacy of MTX in maintaining clinical remission in pSpA. ClinicalTrials.gov, https://clinicaltrials.gov, NCT01426815. © The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: [email protected]

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