A Comparative Research About Effects Of Tapering Or On-demand Tumor Necrosis Factor Inhibitor On Disease Activitiy And Imaging Progression Of Sacroiliac Joints In Axial Spondyloarthritis

Background:Axial spondyloarthritis(axSpA)is a chronic inflammatory disease that mainly affects the axial joints.Non-steroidal anti-inflammatory drugs(NSAIDs)are first-line drugs for the treatment of axSpA,and a tumor necrosis factor inhibitor(TNFi)should be considered in patients with persistently high disease activity despite treatment with NSAIDs.Based on the consideration of pharmaco-economics and safety after long-term use,research on TNFi reduction therapy has also become a hotspot in recent years.Studies have shown that TNFi reduction therapy is feasible in axSpA patients,but these studies are all based on long-term use of sufficient TNFi and the reduction is small,and no effect of reduced TNFi treatment on structural destruction and imaging progression of axSpA patients was observed.Based on the situation illustrated above and combined with the actual national conditions of health economics in China,this study observed the effect of tapering or on-demand TNFi on disease activity control and imaging progression of sacroiliac joints in axSpA patients.Objective:To compare the differences in disease activity and imaging progression of patients with axSpA who had poor response to NSAIDs and were treated with TNFi in a tapering or on-demand manner and those who were treated without TNFi.Methods:We evaluated the patient’s disease activities and imaging progression with informed consent.Therapeutic strategies were made based on the management recommendations for axSpA in 2016 in the combination with patient’s requests.Patients treated with TNFi can recevie TNFi either in tapering(t-TNFi group)or in on-demand(d-TNFi group)manner according to their economic situation and their own requests.Patients treated without TNFi were grouped into the non-TNFi group(n-TNFi group).We recommended that patients should come to our station for follow-up visits every 3-6 months in order to evaluate disease activities and take the magnetic resonance imaging(MRI)detection of sacroiliac joints every 6-12 months.The disease activities and imaging progression among these three groups were compared.Results:A total of 58 axSpA patients were enrolled in this study,including 31 in the t-TNFi group,16 in the d-TNFi group,and 11 in the n-TNFi group.Based on the characteristics of patients’ follow-up and the collected data,we divided the patients’ follow-up time into four periods(1-6 months,7-12 months,13-18 months,and 19-24 months).The results showed that the disease activities in the t-TNFi group at each time period after treatment were significantly improved compared with the baseline level(P values were all <0.05).In the d-TNFi group,the disease activity were significantly improved from baseline during the period of 1-6 months and 13-18 months(P values were all <0.05).There was a statistically significant difference between bath ankylosing spondylitis disease activity index(BASDAI)during 7-12 months and the baseline levels in the n-TNFi group(P = 0.031),while there were no statistical differences in the disease activity between baseline and other periods.For structural damage analysis,there was no statistically significant difference in the improvement of the Spondyloarthritis Research Consortium of Canada(SPARCC)scores among the three groups in different periods.Except that the t-TNFi group had a more significant progression in fat deposition than the n-TNFi group during the period of 7-12 months(P = 0.037),there was no significant difference in the progression of structural destruction among the three groups in other time periods.In the structural damage analysis,fat deposition and erosion were positively correlated with baseline SPARCC scores,and nr-axSpA patients have more advanced fat deposition than AS patients.Conclusion:Administration of TNFi with tapering strategy is more advantageous to axSpA patients than with on-demand strategy and without TNFi usage in improving disease activities continually.However,there was no significant differences in the effects among the effects on the structural damage and imaging progression of these three strategies.Bone marrow edema is an important risk factor for structural damage and imaging progression.In addition,nr-axSpA is more prone to fat deposition progression than AS.