title: Can we reduce the dosage of biologics in spondyloarthritis?
abstract: TNF blockers have revolutionized the management of spondyloarthritis (SpA). To date, four anti-TNFα agents (etanercept, infliximab, adalimumab, golimumab) have been approved for the management of ankylosing spondylitis (AS) and psoriatic arthritis (PsA). The first objective in the management of AS and PsA with TNF inhibitors is to reduce disease activity to clinical remission or low disease activity. After remission has been achieved, this state should be maintained as long as possible. However, the financial burden associated with the cost of anti-TNF agents as well as concerns about their long-term safety suggest reducing the dosage of the drug or discontinuing the therapy in the hopes of drug-free remission. The aim of this review is to examine what has, till now, been published on this topic in axial SpA, which includes AS and non-radiographic axial SpA (nr-axSpA), peripheral SpA and PsA. Discontinuation of therapy in axial SpA is not possible in the majority of patients, while on the contrary, reducing the dosage often is. In some patients with peripheral SpA and PsA it is also possible to discontinue therapy and to achieve drug-free remission.
authors.affiliation: Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Potenza and Matera, Italy. ignazioolivieri@tiscalinet.it
authors.forename: Ignazio
authors.initials: I
authors.lastname: Olivieri
authors.forename: Salvatore
authors.initials: S
authors.lastname: D'Angelo
authors.forename: Angela
authors.initials: A
authors.lastname: Padula
authors.forename: Pietro
authors.initials: P
authors.lastname: Leccese
authors.forename: Angelo
authors.initials: A
authors.lastname: Nigro
authors.forename: Carlo
authors.initials: C
authors.lastname: Palazzi
mesh_terms: D000911:Antibodies, Monoclonal / Q000191:economics / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000191:economics / Q000627:therapeutic use; D001688:Biological Products / Q000627:therapeutic use*; D006801:Humans; D025241:Spondylarthritis / Q000188:drug therapy*; D013167:Spondylitis, Ankylosing / Q000188:drug therapy / Q000628:therapy
chemical_list: D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D001688:Biological Products