Real life experience confirms sustained response to long-term biologics and switching in ankylosing spondylitis

Objective. To investigate the long-term response to biological therapies in AS in a real life clinical setting and to quantify non-response and response to ‘switching’ therapies in these cases. Methods. All patients prescribed TNF-blocking therapies for AS between 1999 and 2006 were studied. Respons...

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Published in:Rheumatology (Oxford, England) England), 2008-06, Vol.47 (6), p.897-900
Main Authors: Coates, L. C., Cawkwell, L. S., Ng, N. W. F., Bennett, A. N., Bryer, D. J., Fraser, A. D., Emery, P., Marzo-Ortega, H.
Format: Article
Language:English
Subjects:
Adalimumab
Adult
Ankylosing spondylitis
Anti-Inflammatory Agents, Non-Steroidal - therapeutic use
Antibodies, Monoclonal - therapeutic use
Antibodies, Monoclonal, Humanized
Antirheumatic Agents - therapeutic use
Biological and medical sciences
Biologics
Diseases of the osteoarticular system
Diseases of the spine
Drug Evaluation
Drug Therapy, Combination
Etanercept
Female
Humans
Immunoglobulin G - therapeutic use
Inflammatory joint diseases
Infliximab
Male
Medical sciences
Middle Aged
Non-response
Receptors, Tumor Necrosis Factor - therapeutic use
Retrospective Studies
Severity of Illness Index
Spondylitis, Ankylosing - drug therapy
Switching
TNF blockers
Treatment
Treatment Outcome
Tumor Necrosis Factor-alpha - antagonists & inhibitors
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Summary:Objective. To investigate the long-term response to biological therapies in AS in a real life clinical setting and to quantify non-response and response to ‘switching’ therapies in these cases. Methods. All patients prescribed TNF-blocking therapies for AS between 1999 and 2006 were studied. Response was evaluated using Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI) and CRP results. Results. A total of 113 patients (84 males: 29 females, mean age 45 yrs, median disease duration 16 yrs, 87% HLA-B27 positive) were identified. At baseline they had a mean BASDAI of 6.57, BASFI 6.57 and CRP of 31 g/dl. At the end of follow-up, these values had reduced to mean BASDAI of 3.12, BASFI 4.16 and CRP of 7 g/dl. Improvements were sustained for 24 months and beyond with no loss of effect. Only nine patients (8%) suffered side-effects leading to cessation or switching of first-line therapy and non-response occurred in 15 patients (13%) in the long term. Fifteen patients (13%) switched to a second drug and 14 of these (93%) had a significant and sustained response. Outcomes were similar regardless of drug used, duration of disease and HLA-B27 status. Conclusion. Treatment of active AS with TNF blockers according to the British Society of Rheumatology guidelines leads to a sustained response for over 2 yrs with most patients tolerating the drugs well. The rate of non-response is significantly lower than that seen in RA and nearly all of these patients respond well to a second-line agent.
ISSN:1462-0324
1462-0332
DOI:10.1093/rheumatology/ken094