None of the authors have any conflicts of interest to disclose regarding this manuscript.
ML participated in drafting the manuscript as well as analyzing, acquiring and interpreting the data. RR and LP conceived and designed the study and participated in data processing and in drafting the manuscript. FO performed statistical analysis and participated in analyzing and interpreting the data. PF and AO participated in acquiring the data. All the authors have made substantive intellectual contributions to the study, have reviewed the article, and have given the final approval of the version being submitted.
The advent of anti-tumor necrosis factor-α (TNFα) drugs has changed the course of ankylosing spondylitis (AS). While data are available concerning the long term effectiveness of single anti-TNF agents, little has been published about predictors of treatment response in AS. The aim of this retrospective study was to evaluate the survival, effectiveness, and safety of infliximab over a 5-year period and to identify predictors of disease outcome.
Seventy AS patients attending the Rheumatology Clinic of the University of Padua who were treated with intravenous infliximab at 0, 2, 4 weeks and then every 6, 8, or up to 16 weeks were studied retrospectively. Demographic information, laboratory inflammatory and disease indices (BASDAI, BASFI, BASMI) were collected (at baseline, 3, 6, 12 months and once a year thereafter). Clinical improvement, drug tolerability, adverse events/side effects and causes leading to discontinuation were recorded.
Infliximab caused a rapid, persistent improvement at all the assessment times in the BASDAI 50 (71.4 %) and ASDAS scores (97.1 % in ASAS20, 80 % in ASAS40, 80 % in ASAS5/6), and already within 6 months of beginning treatment in 50 % percent of the patients. The other 50 % withdrew because of: adverse events (12 = 34.3 %), side effects (5 = 14.3 %), drug inefficacy (12 = 34.3 %), spontaneously (4 = 11.4 %). Those who did not respond were prevalently females (34.3 % vs 17.1 %).
Factors such as female sex, use of steroids, persistently high inflammatory levels, BASFI and BASDAI indices were found to be negative predictors of treatment response. Infliximab was found to be safe, effective and well-tolerated; it elicited satisfactory long term response and drug survival rates.
Dougados M, Dijkmans B, Khan M, Maksymowych W, van der Linden S, Brandt J. Conventional treatments for ankylosing spondylitis. Ann Rheum Dis. 2002;61Suppl 3:iii40–50.
Chen J, Liu C, Lin J. Methotrexate for ankylosing spondylitis. Cochrane Database Syst Rev. 2006;4, CD004524. PubMed
Braun J, Zochling J, Baraliakos X, Alten R, Burmester G, Grasedyck K, et al. Efficacy of sulfasalazine in patients with inflammatory back pain due to undifferentiated spondyloarthritis and early ankylosing spondylitis: a multicenter randomized controlled trial. Ann Rheum Dis. 2006;65:1147–53. CrossRefPubMedPubMedCentral
Coates LC, Cawkwell LS, Ng NW, Bennett AN, Bryer DJ, Fraser AD, et al. Real life experience confirms sustained response to long-term biologics and switching in ankylosing spondylitis. Rheumatology (Oxford). 2008;47:897–900. CrossRef
Baraliakos X, van den Berg R, Braun J, van der Heijde D. Update of the literature review on treatment with biologics as a basis for the first update of the ASAS/EULAR management recommendations of ankylosing spondylitis. Rheumatology (Oxford). 2012;51:1378–87. CrossRef
Breban M, Vignon E, Claudepierre P, Devauchelle V, Wendling D, Lespessailles E, et al. Efficacy of infliximab in refractory ankylosing spondylitis: results of a six-month open-label study. Rheumatology (Oxford). 2002;41:1280–85. CrossRef
Braun J, Baraliakos X, Listing J, Fritz C, Alten R, Burmester G, et al. Persistent clinical efficacy and safety of anti-tumour necrosis factor alpha therapy with infliximab in patients with ankylosing spondylitis over 5 years: evidence for different types of response. Ann Rheum Dis. 2008;67:340–5. CrossRefPubMed
Arends S, Brouwer E, van der Veer E, Groen H, Leijsma MK, Houtman PM, et al. Baseline predictors of response and discontinuation of tumor necrosis factor-alpha blocking therapy in ankylosing spondylitis: a prospective longitudinal observational cohort study. Arthritis Res Ther. 2011;13:R94. CrossRefPubMedPubMedCentral
Baraliakos X, Listing J, Fritz C, Haibel H, Alten R, Burmester GR, et al. Persistent clinical efficacy andsafety of infliximab in ankylosing spondylitis after 8 years--early clinical response predicts long term outcome. Rheumatology (Oxford). 2011;50:1690–9. CrossRef
Spadaro A, Lubrano E, Marchesoni A, D'Angelo S, Ramonda R, Addimanda O, et al. Remission in ankylosing spondylitis treated with anti-TNF-α drugs: a national multicentre study. Rheumatology (Oxford). 2013;52:1914–19. CrossRef
Bunchuk NV, Rumiantseva OA, Loginova EI, Bochkova AG, Storozhakov GI, Ettinger OA, et al. The efficacy and safety of infliximab in patients with ankylosing spondylitis: results of an open-labeled multicenter study. Ter Arkh. 2010;82:41–6. PubMed
Pavelka K, Forejtová S, Stolfa J, Chroust K, Buresová L, Mann H, et al. Anti- TNF therapy of ankylosing spondylitis in clinical practice. Results from the Czech national registry ATTRA. Clin Exp Rheumatol. 2009;27:958–63. PubMed
Glintborg B, Østergaard M, Krogh NS, Tarp U, Manilo N, Loft AG, et al. Clinical response, drug survival and predictors thereof in 432 ankylosing spondylitis patients after switching tumour necrosis factor α inhibitor therapy: results from the Danish nationwide DANBIO registry. Ann Rheum Dis. 2013;72:1149–55. CrossRefPubMed
Glintborg B, Ostergaard M, Krogh NS, Dreyer L, Kristensen HL, Hetland ML. Predictors of treatment response and drug continuation in 842 patients with ankylosing spondylitis treated with anti-tumour necrosis factor: results from 8 years' surveillance in the Danish nationwide DANBIO registry. Ann Rheum Dis. 2010;69:2002–8. CrossRefPubMed
Maksymowych WP, Jhangri GS, Lambert RG, Mallon C, Buenviaje H, Pedrycz E, et al. Infliximab in ankylosing spondylitis: a prospective observational inception cohort analysis of efficacy and safety. J Rheumatol. 2002;29:959–65. PubMed
Spadaro A, Punzi L, Marchesoni A, Lubrano E, Mathieu A, Cantini F, et al. Switching from infliximab or etanercept to adalimumab in resistant or intolerant patients with spondyloarthritis: a 4-year study. Rheumatology (Oxford). 2010;49:1107–11. CrossRef
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