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We screened, extracted data, and assessed risk of bias in duplicate. Data were pooled using random\u2010effects models; subgroup analyses were performed for type of TNFi, prior TNFi exposure, and follow\u2010up duration. Outcomes of interest were Assessment of SpondyloArthritis international Society (ASAS) response and remission criteria, disease activity, relapse, and safety.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We included 6 randomized trials with 747 participants (442 with ankylosing spondylitis and 305 with nonradiographic axial SpA). Compared to the standard dose, there were fewer events with the reduced dose for the ASAS criteria for 40% improvement (risk ratio [RR] 0.62 [95% confidence interval (95% CI) 0.49, 0.78]) and for ASAS partial remission (RR 0.17 [95% CI 0.06, 0.46]). There was a mean increase in the Bath Ankylosing Spondylitis Disease Activity Index score (mean difference [MD] 0.35 [95% CI 0.10, 0.60]) and no difference in C\u2010reactive protein levels (MD 0.16 [95% CI \u20130.76, 1.07]) with the reduced dose. There were more disease flares\/relapses (RR 1.73 [95% CI 1.32, 2.27]) with the reduced dose. There were no differences in infection rates (incidence rate ratio [IRR] 0.98 [95% CI 0.76, 1.25]) or injection\/infusion reactions (IRR 0.71 [95% CI 0.42, 1.19]).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Patients with axial SpA may experience little to no clinical benefit from reduction of TNFi therapy. Maintaining the standard dose probably improves the sustained effect on disease activity and helps to prevent disease flare.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acr.24184","type":"journal-article","created":{"date-parts":[[2020,3,12]],"date-time":"2020-03-12T22:47:45Z","timestamp":1584053265000},"page":"861-872","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Tumor Necrosis Factor Inhibitor Dose Reduction for Axial Spondyloarthritis: A Systematic Review and Meta\u2010Analysis of Randomized Controlled Trials"],"prefix":"10.1002","volume":"73","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6487-3367","authenticated-orcid":false,"given":"Daeria O.","family":"Lawson","sequence":"first","affiliation":[{"name":"McMaster University, Hamilton, and Toronto Western Hospital  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Eraso","sequence":"additional","affiliation":[{"name":"Toronto Western Hospital  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lawrence","family":"Mbuagbaw","sequence":"additional","affiliation":[{"name":"McMaster University and St. Joseph\u2019s Healthcare Hamilton  Hamilton Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marianinha","family":"Joanes","sequence":"additional","affiliation":[{"name":"Boston University School of Medicine  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theresa","family":"Aves","sequence":"additional","affiliation":[{"name":"St. Michael\u2019s Hospital  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alvin","family":"Leenus","sequence":"additional","affiliation":[{"name":"McMaster University  Hamilton Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Omar","sequence":"additional","affiliation":[{"name":"Toronto Western Hospital  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert D.","family":"Inman","sequence":"additional","affiliation":[{"name":"Toronto Western Hospital University of Toronto, and Toronto Western Hospital  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,6,3]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/med\/9780198734444.001.0001"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2008.104018"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1038\/ncprheum0219"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1038\/ncprheum0118"},{"key":"e_1_2_7_6_1","first-page":"CD005468","article-title":"TNF\u2010alpha inhibitors for ankylosing spondylitis","author":"Maxwell LJ","year":"2015","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2016-210770"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.2217\/imt.10.67"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10067-015-2959-1"},{"issue":"78","key":"e_1_2_7_10_1","first-page":"S43","article-title":"Withdrawal of biologic therapy in axial spondyloarthritis: the experience in established disease","volume":"31","author":"Baraliakos X","year":"2013","journal-title":"Clin Exp Rheumatol"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kew464"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kew033"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00296-015-3288-z"},{"key":"e_1_2_7_14_1","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1007\/s10067-013-2372-6","article-title":"Low doses of etanercept can be effective to maintain remission in ankylosing spondylitis patients","volume":"33","author":"De Stefano R","year":"2014","journal-title":"Clin Rheumatol"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kel156"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10067-007-0674-2"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.141128"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.170057"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.b2535"},{"key":"e_1_2_7_20_1","unstructured":"LawsonDO ErasoM MbuagbawL JoanesM AvesT LeenusA et al.TNF inhibitor dose tapering in axial spondyloarthritis: a systematic review and meta\u2010analysis.2018. 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