One-Fourth of Patients With NrAxSpa Experience No Disease Flare After Stopping Etanercept

After discontinuing etanercept treatment, a quarter of patients with nonradiographic axial spondyloarthritis (NrAxSpa) maintained inactive disease over 40 weeks, according to a study published in The Journal of Rheumatology.

“An early, aggressive, treat-to-target approach is recommended in axSpa to improve outcomes. Another benefit of this strategy may determine whether some patients can maintain remission after expensive biologic treatment is discontinued,” wrote corresponding author Filip Van den Bosch, MD, PhD, of Ghent University in Belgium, and coauthors. “Results from RE-EMBARK suggest that treatment goals can be achieved even after etanercept discontinuation in some (ie 25%) patients.”

The open label, phase IV RE-EMBARK trial included 209 patients with NrAxSpa. In part 1, all patients received etanercept and a background nonsteroidal antiinflammatory drug over 24 weeks. Patients who achieved inactive disease entered part 2 of the study and discontinued etanercept for up to 40 weeks. Patients who experienced a disease flare during part 2 moved on to part 3 and restarted etanercept.

During part 1, 59% of patients achieved inactive disease on etanercept, according to the study. During part 2 when etanercept was stopped, 22% of patients experienced a disease flare within the first 28 days. By week 40, the proportion who experienced a disease flare reached 75%.

During part 3, when patients restarted etanercept treatment after a disease flare, 62% again achieved inactive disease, researchers reported.

The absence of the combination of sacroiliitis detected on magnetic resonance imaging and high high-sensitivity C-reactive protein at baseline predicted maintenance of inactive disease after stopping etanercept, multivariable analysis showed. Male sex and age younger than 40 years predicted the reattainment of inactive disease upon restarting etanercept treatment.

Reference: 
Van den Bosch F, Wei JC, Nash P, et al. Etanercept withdrawal and retreatment in nonradiographic axial spondyloarthritis: results of RE-EMBARK, an open-label phase IV trial. J Rheumatol. 2023;50(4):478-487. doi:10.3899/jrheum.220353