9/16/2024
A recent study investigated the effects of tapering tumor necrosis factor inhibitors (TNFi) like Enbrel, Remicade, and Humira on drug levels in patients with inflammatory arthritis. Researchers compared reducing TNFi doses based on disease activity to maintaining a stable dose. They also examined how tapering affected disease control and the development of anti-drug antibodies (ADAb), which are produced by the immune system and can reduce a medication’s effectiveness by binding to the TNFi drug.
The study analyzed data from 129 participants with rheumatoid arthritis (RA), psoriatic arthritis (PsA), or axial spondyloarthritis (axSpA) who had been on stable TNFi doses for at least 12 months. The participants were randomly assigned to either a tapering group or a control group, which continued their usual doses.
In the tapering group, doses were reduced using a disease activity-guided algorithm, extending the time between doses by about 25% every four months until the medication was significantly reduced or stopped. Blood samples were taken at baseline, 12 months, and 18 months to measure TNFi levels and detect ADAb.
Results showed a significant shift in TNFi drug levels after 18 months. In the tapering group, there was a 14% decrease in patients with high drug levels and an 18% increase in those with low levels. Despite this, disease activity remained stable across both groups, with minimal differences in disease activity scores. ADAb were found in 8 patients, all in the tapering group. However, neither drug levels nor ADAb reliably predicted successful tapering.
In conclusion, tapering TNFi in inflammatory arthritis can maintain disease control for many patients. Though drug levels dropped, most maintained stable symptoms. The occurrence of ADAb was low, indicating that monitoring TNFi levels and ADAb may not be the best way to guide tapering decisions. More research is needed to identify which patients benefit most from tapering.
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