TNF Inhibitor Tapering Safe, Effective for 2 Years in PsA and AxSpA

A recent study demonstrated the sustained efficacy and safety of tumor necrosis factor (TNF) inhibitor tapering for up to 2 years in patients with psoriatic arthritis (PsA) and axial spondylarthritis.1

DRESS-PS, an open-label trial conducted in Nijmegen and the Netherlands, showed the safety and efficacy of TNF inhibitor tapering up to 12 months in patients aged ≥ 16 years with PsA or axial spondylarthritis who had stable low disease activity for ≥ 6 months before baseline.

Investigators, led by Amy C D Peeters, MD, from the department of rheumatology at Sint Maartenskliniek in the Netherlands, recently published results of the 12-month observational extension of DRESS-PS in The Lancet Rheumatology.1The data were previously presented at the ACR Convergence 2023 meeting on November 12, 2023, by Celia A J Michielsens from Sint Maartenskliniek and colleagues.2

In this extension, investigators sought to see whether tapering at 24 months made a difference from tapering at 12 months.1 During the original DRESS-PS trial, patients were randomly assigned to either a treat-to-target tapering strategy (the intervention arm) or a treat-to-target strategy without tapering. The intervention arm widened the interval between TNF inhibitor doses, going from 100% to 66%, 50%, or 0% of the defined daily dose. All patients who participated in the DRESS-PS trial were eligible to participate in this extension study.

The primary outcome of this extension study was the proportion of patients in each group (intervention vs control) who had low disease activity at 24 months. To account for missing data, the analysis was done both with and without imputation. The difference between groups was compared against a 20% non-inferiority margin from the original DRESS-PS trial, meaning the intervention would be considered not worse than control if it was within 20%.1 Secondary outcomes included HAQ-DI, BASFI, and quality of life measured with EQ5D, SF12, and ASAS-HI.2

Investigators recruited 122 patients between January 8, 2020, and October 10, 2022.1 In total, 114 participated in the extension study, with 79 from the original intervention arm (40 with PsA; 39 with axial spondylarthritis), and 35 from the original control arm (18 with PsA; 17 with axial spondylarthritis). The sample had a mean age of 50 years, and more than half were males (61%).

In the study, 67% and 72% of patients with PsA and axial spondylarthritis, respectively, had a low disease activity at 24 months, with an adjusted difference of 5% (95% confidence interval [CI], -15 to 24; P = .64).1 This exceeded the prespecified non-inferiority margin. When accounting for missing data, the adjusted difference was 2% (-18 to 16; P = .85), falling within the non-inferiority margin.

Over 24 months, the intervention arm had a 10% greater incidence of patients experiencing ≥ 1 adverse event compared with the control arm (99% vs 89%; P = .060).1 Investigators observed no significant differences between arms in adverse events of special interest—namely, infections and injection site reactions.

Moreover, investigators observed similar functioning and quality of life at 12 months and 24 months among patients who tapered TNF inhibitors.2 Participants who tapered had the following median scores at 24 months vs controls: EQ-5D-3L (0.84 vs 0.84), SF-12 PCS (44.4 vs 44.0), SF-12 MCS (55.0 vs 56.1), ASAS-HI (5 vs 4), HAQ-DI (0.25 vs 0.31), and BASFI (1.95 vs 1.70).

“Future research should explore the challenges to implementation of tapering strategies in routine care in these patients,” investigators concluded.1

References

1. Peeters ACD, Michielsens CAJ, Mahler EAM, et al. Effectiveness of treat-to-target tapering of TNF inhibitors for psoriatic arthritis and axial spondyloarthritis in the Netherlands: 24-month follow-up of the DRESS-PS trial. Lancet Rheumatol. Published online July 24, 2025. doi:10.1016/S2665-9913(25)00070-0

2. Peeters A, Michielsens C, Mahler E, Verhoef L, den Broeder A, den Broeder N, van Herwaarden N. Effectiveness of Dose Reduction and Withdrawal Strategies of TNF Inhibitors in Psoriatic Arthritis and Axial Spondyloarthritis: Long Term Extension of the DRESS-PS Study [abstract]. Arthritis Rheumatol. 2023; 75 (suppl 9). https://acrabstracts.org/abstract/effectiveness-of-dose-reduction-and-withdrawal-strategies-of-tnf-inhibitors-in-psoriatic-arthritis-and-axial-spondyloarthritis-long-term-extension-of-the-dress-ps-study/. Accessed August 15, 2025.