Patient-tailored dose reduction of TNF-alpha blocking agents in ankylosing spondylitis patients with stable low disease activity in daily clinical practice

ObjectiveTumour necrosis factor-alpha (TNF-alpha) blocking agents are very, effective in controlling systemic inflammation and improving clinical assessments in ankylosing spondylitis (AS). In view of potential side effects and high costs of long-term treatment, our aim was to investigate whether dose reduction of TNF-alpha blocking agents is possible without loss of effectiveness in AS patients in daily clinical practice.MethodsPatients from the prospective observational GLAS cohort, fulfilling the modified New York criteria for AS, with active disease before start of TNF-alpha blocking therapy and stable (>= 6 months) low disease activity on the conventional dose regimen, who started with dose reduction of TNF-alpha blocking therapy before June 2011 were studied. Dose reduction was patient-tailored (step-by-step approach) and consisted of lowering the dose and/or extending the interval between dosesResultsBetween June 2005 and March 2011, 58 AS patients started dose reduction of etanercept (n=39), infliximab (n=10), or adalimumab (n=9). Of all patients, 74%, 62%, and 53% maintained their reduced dose or dosing frequency after 6, 12, and 24 months, respectively. The mean dose of TNF-alpha blocking therapy over time corresponded to 62% of the standard dose regimen. Disease activity remained low in the majority of patients who maintained dose reduction after 24 months (94% had BASDAIConclusionIn this observational cohort, patient-tailored dose reduction of TNF-alpha blocking agents was successful preserving stable low disease activity over 24 months in approximately half of the AS patients.