Treat-to-Target TNFi Tapering Maintains Effectiveness at 24 Months Among Patients With PsA, axSpA

A Dutch study found that tapering tumor necrosis factor inhibitors in psoriatic arthritis and axial spondyloarthritis is noninferior to full-dose continuation for maintaining low disease activity over 24 months.

In the 24-month observational extension of the DRESS-PS trial, 114 of 122 patients were originally randomized to treat-to-target tapering—extending dosing intervals to 66%, 50%, or discontinuation—or to standard dosing. During the extension, tapering was allowed for all patients, with shared decision-making guiding treatment.

The primary outcome assessed whether low disease activity was maintained between groups. At 24 months, 67% of the tapering group and 72% of the standard-dose group maintained low disease activity, with an adjusted difference of 5% (95% CI –15 to 24; p=0.64). With imputed data, the adjusted difference was 2% (95% CI –18 to 16; p=0.85), which met the prespecified noninferiority margin of 20%.

Safety outcomes showed that nearly all patients in the tapering group (99%) and 89% in the continuation group experienced at least one adverse event, but no significant differences were found in infections or injection site reactions. Investigators noted that while adverse events were frequent, they were comparable between groups.

“Treat-to-target tapering of TNF inhibitors remains effective and safe for the maintenance of low disease activity for up to 2 years,” the authors reported. They added that future research should address the practical challenges of implementing tapering strategies in routine clinical practice.

Reference
Peeters AC, 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. 2025;7(9):e642-e651.