EULAR Latest News| Videos Anti-TNF Doses Can Be Cut in Spinal Arthritis By Nancy Walsh, Staff Writer, MedPage Today Published: June 16, 2013 Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco For best viewing, click the bottom right corner for full screen. Action Points This study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal. Many patients with ankylosing spondylitis who have low disease activity on treatment with TNF inhibitors can reduce the dose of their biologic. Point out that the mean dose reduction in the patients able to reduce their TNF-inhibitor dose was 37%. MADRID -- Many patients with ankylosing spondylitis who have low disease activity on treatment with tumor necrosis factor (TNF) inhibitors can reduce the dose of their biologic, a researcher said here. Among patients who reduced their anti-TNF dose once they achieved a state of low disease activity, 42% remained on the lower dose 2 years later, according to Suzanne Arends, PhD, of University Medical Center in Groningen, the Netherlands, and colleagues. Overall, the mean dose reduction in these patients was 37%, she reported in a poster session at the annual meeting of the European League Against Rheumatism. "The main message of the study was that if patients are doing okay, they can try to lower their dose," she told MedPage Today. TNF inhibitors have been shown to be very effective in controlling the inflammation associated with ankylosing spondylitis and in improving the clinical features of disease. However, the high cost and potential for adverse events with biologic therapy have prompted questions about whether doses can be reduced once patients have responded to therapy. Arends and colleagues conducted a prospective, real-world study that included 49 patients with low disease activity who had been treated with etanercept (Enbrel), adalimumab (Humira), or infliximab (Remicade) between 2005 and 2011. Almost all of the patients were men. The mean age was 46, mean symptom duration was 20 years, and 83% were HLA-B27 positive. Disease activity, as measured on the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) before treatment averaged 6.2, with a score of 4 or higher representing active disease. Before dose reduction, all patients had maintained a BASDAI below 4 for at least 6 months on a conventional dose regimen, and the mean score at the time of dose reduction was 1.8. Six months after starting the lower dose, 71% had not needed to increase their dose. At 12 months, 54% continued to have low disease activity, as did 47% at 18 months. Scores on BASDAI remained below 4 in 88% at 6 months, in 83% at 12 months, in 89% at 18 months, and in 86% at 2 years. "The dose reduction was patient-tailored, and they could either lower the dose or extend the interval between doses," Arends said. "Some patients even initiated the dose reduction themselves, when they were doing well," she added. A total of 25 patients experienced a disease flare, and of these, 23 returned to conventional doses of the TNF inhibitors and were once again able to attain low disease activity. Two stopped anti-TNF treatment, one because of an adverse event and one because a lack of efficacy associated with the development of antibodies. Limitations of the study included its small number of patients, 2-year follow-up, and reliance on subjective assessment of symptoms. Arends and her colleagues plan to further examine more objective measures of disease and to look at the effects of dose lowering on radiographic progression in ankylosing spondylitis. The authors reported no conflicts of interest. Primary source: European League Against Rheumatism Source reference: Arends S, et al "Successful dose reduction of TNF-alpha blocking agents in ankylosing spondylitis patients with stable low disease activity" EULAR 2013; Abstract FRI0422. Add Your Knowledge ™ Nancy Walsh Staff Writer Nancy Walsh has written for various medical publications in the United States and England, including Patient Care, The Practitioner, and the Journal of Respiratory Diseases. She also has contributed numerous essays to several books
Posted on: Mon, 17 Jun 2013 13:33:55 +0000
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