AS: Drug Withdrawal & Flare

Many patients couldn’t get back into remission when adalimumab was reinstated.

Almost a third of patients with non-radiographic axial spondyloarthritis remained in remission 6 months after Adalimumab withdrawal. Most patients in remission would be sorely tempted to give it a shot, if one considers that up to half of those remaining on treatment also experienced a disease flare in that same period. A cautionary note: less than 60% of those who resumed treatment regained disease control.

The stats don’t look particularly encouraging either way; so if you‘re paying for biologics out of pocket, or are particularly concerned about possible treatment side-effects, drug withdrawal (with on-demand re-induction if and when necessary) may be an option, especially since there did not appear to be any difference of drug cessation on quality of life measures in this study.

But perhaps another (more sensible?) option is drug tapering rather than sudden death drug withdrawal, with possible therapy intensification whenever disease activity suggests a pending flare. Fuzzy logic treatment strategy, anyone?