title: Anti-TNF discontinuation and tapering strategies in patients with axial spondyloarthritis: a systematic literature review.
abstract: The aim was to evaluate whether anti-TNF discontinuation and tapering strategies are efficacious for maintaining remission or low disease activity (LDA) in patients with axial spondyloarthritis.
  
  
  
  A systematic literature review up to September 2014 was performed using Medline, EMBASE and Cochrane databases. Longitudinal studies evaluating the efficacy of discontinuation/tapering of anti-TNF therapy to maintain clinical response achieved after receiving a standard dose of the same drug were included. The results were grouped according to the type of strategy (discontinuation or tapering) evaluated.
  
  
  
  Thirteen studies out of 763 retrieved citations were included. Overall, published data are scarce and the level of evidence of the studies is weak. Five studies provided evidence for assessing discontinuation strategy. The frequency of patients developing flare during the follow-up period ranged between 76 and 100%. The median (range) follow-up period was 52 (36-52) weeks and time to flare 16 (6-24) weeks. Additionally, eight studies evaluating tapering strategy were selected. The percentage of patients maintaining LDA or remission was reported in five studies and ranged between 53 and 100%. The remaining three studies reported the mean change in BASDAI and CRP after reducing the anti-TNF dose and did not observe any relevant increase in these parameters.
  
  
  
  Published data indicate that a tapering strategy for anti-TNF therapy is successful in maintaining remission or LDA in most patients with axial spondyloarthritis. However, a discontinuation strategy is not recommended because it leads to flare in most cases. Further studies with an appropriate design covering the whole spectrum of the disease are required to confirm these results.
authors.affiliation: Department of Rheumatology, IdiPaz, University Hospital La Paz, mvictoria.navarroc@gmail.com.
authors.forename: Victoria
authors.initials: V
authors.lastname: Navarro-Compán
authors.affiliation: Department of Rheumatology, IdiPaz, University Hospital La Paz.
authors.forename: Chamaida
authors.initials: C
authors.lastname: Plasencia-Rodríguez
authors.affiliation: Department of Rheumatology, IdiPaz, University Hospital La Paz.
authors.forename: Eugenio
authors.initials: E
authors.lastname: de Miguel
authors.affiliation: Research Unit, Spanish Society of Rheumatology, Madrid and.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Balsa
authors.affiliation: Department of Rheumatology, IdiPaz, University Hospital La Paz.
authors.forename: Emilio
authors.initials: E
authors.lastname: Martín-Mola
authors.affiliation: Research Unit, Spanish Society of Rheumatology, Madrid and.
authors.forename: Daniel
authors.initials: D
authors.lastname: Seoane-Mato
authors.affiliation: Department of Rheumatology, Hospital Clinic and IDIBAPS, Barcelona, Spain.
authors.forename: Juan D
authors.initials: JD
authors.lastname: Cañete
mesh_terms: D000328:Adult; D018501:Antirheumatic Agents / Q000008:administration & dosage*; D001368:Axis, Cervical Vertebra; D018450:Disease Progression; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D025241:Spondylarthritis / Q000188:drug therapy* / Q000473:pathology; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D028761:Withholding Treatment
chemical_list: D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha
keywords: anti-TNF; axial spondyloarthritis; discontinuation; tapering