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Patient-tailored dose reduction of TNF-α blocking agents in ankylosing spondylitis patients with stable low disease activity in daily clinical practice
S. Arends1, E. Van Der Veer2, F.B. Kamps3, P.M. Houtman4, R. Bos5, H. Bootsma6, E. Brouwer7, A. Spoorenberg8
- Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; and Rheumatology, Medical Center Leeuwarden, The Netherlands.
- Laboratory Medicine, University of Groningen, University Medical Center Groningen, The Netherlands.
- Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, The Netherlands.
- Rheumatology, Medical Center Leeuwarden, The Netherlands.
- Rheumatology, Medical Center Leeuwarden, The Netherlands.
- Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, The Netherlands.
- Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, The Netherlands.
- Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; and Rheumatology, Medical Center Leeuwarden, The Netherlands.
CER7779
2015 Vol.33, N°2
PI 0174, PF 0180
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PMID: 25797228 [PubMed]
Received: 24/07/2014
Accepted : 13/10/2014
In Press: 10/03/2015
Published: 10/04/2015
Abstract
OBJECTIVES:
Tumour necrosis factor-alpha (TNF-α) blocking agents are very effective in controlling systemic inflammation and improving clinical assessments in ankylosing spondylitis (AS). In view of potential side effects and high costs of long-term treatment, our aim was to investigate whether dose reduction of TNF-α blocking agents is possible without loss of effectiveness in AS patients in daily clinical practice.
METHODS:
Patients from the prospective observational GLAS cohort, fulfilling the modified New York criteria for AS, with active disease before start of TNF-α blocking therapy and stable (≥6 months) low disease activity on the conventional dose regimen, who started with dose reduction of TNF-α blocking therapy before June 2011 were studied. Dose reduction was patient-tailored (step-by-step approach) and consisted of lowering the dose and/or extending the interval between doses.
RESULTS:
Between June 2005 and March 2011, 58 AS patients started dose reduction of etanercept (n=39), infliximab (n=10), or adalimumab (n=9). Of all patients, 74%, 62%, and 53% maintained their reduced dose or dosing frequency after 6, 12, and 24 months, respectively. The mean dose of TNF-α blocking therapy over time corresponded to 62% of the standard dose regimen. Disease activity remained low in the majority of patients who maintained dose reduction after 24 months (94% had BASDAI<4). If there was recurrence of disease symptoms, patients achieved good clinical response after returning to the conventional regimen (88% reached BASDAI<4).
CONCLUSIONS:
In this observational cohort, patient-tailored dose reduction of TNF-α blocking agents was successful preserving stable low disease activity over 24 months in approximately half of the AS patients.
