Dr. Fardina Malik, a rheumatologist in the Department of Medicine at NYU Langone Health in New York City, says by email, “Despite how happy patients are about achieving remission, they are always concerned about the side effects (e.g., malignancy risk, infections) and want to know if they can either taper or get completely off the medication once the axial SpA symptoms are under control.”
“But until now,” adds Dr. Malik, who also was not involved in the study, “we did not have data from randomized controlled trials to answer patients’ questions about their likelihood of flaring when they get off adalimumab.”
“These results might suggest the importance of treating patients aggressively early in their disease process (prior to development of radiographic disease) to achieve remission,” she notes. “I value and practice shared-decision making with my patients and feel more informed and certain about the risk of flare when they decide to discontinue after achieving remission.”
Dr. Malik adds that the findings “might be extrapolated to other TNF inhibitors,” and that “strengths of the study include its “large and adequate sample size, double-blind randomized design, clarity of statistical plan and description.”
But she adds that providers need to be cautious about applying these findings to patients of various races.
AbbVie funded the study. Most authors have financial relationships with the company.
- Landewé R, Sieper J, Mease P, et al. Efficacy and safety of continuing versus withdrawing adalimumab therapy in maintaining remission in patients with non-radiographic axial spondyloarthritis (ABILITY-3): a multicentre, randomised, double-blind study. Lancet. 2018 Jul 14;392(10142):134–144. doi: 10.1016/S0140-6736(18)31362-X. Epub 2018 Jun 29.
- Braun J. Discontinuing tumour necrosis factor inhibitors in non-radiographic axial spondyloarthritis. Lancet. 2018 Jul 14;392(10142):98–100. doi: 10.1016/S0140-6736(18)31440-5. Epub 2018 Jun 28.