Optimizing treatment of biologics for ankylosing spondylitis

Zexin CHEN; Yang CUI

ABSTRACT

Objective:

The current evidence suggests that tumor necrosis factor-inhibitor (TNFi) treatment can be used to achieve clinical remission or low disease activity in patients with ankylosing spondylitis (AS). After achieving remission / low disease activity, however, the follow-up treatment options are unclear. The purpose of this review is to conduct an extensive and systematic literature review of the studies conducted from September 2014 to July 2020 to assess the feasibility and effectiveness of tapering of biological agents.

Methods:

After searching for the related papers and abstracts and applying inclusion/exclusion criteria, a structured extraction process was used to include the studies into this study.

Results:

A total of 13/93 studies were included into the analysis of the tapering of biological agents in AS patients, in which 7/13 adopted the dose reduction regimen, 3/13 adopted the extended interval between doses regimen, and 5/13 did not provide or formulate the detailed reduction regimen. We summarized the feasibility of TNFi tapering schemes in the published studies and summarized the tapering rules. Only one study showed that reduced TNFi levels worsened the quality of life and resulted in a relapse within 12 months.

Conclusion:

More research is needed to understand the long-term effects of these strategies on efficacy, safety, and cost in the treatment of AS.