Tailored anti-TNF-alpha dose successful in patients with AS

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Arends S, et al. Clin Exp Rheumatol. 2015;Epub ahead of print

About half of patients with ankylosing spondylitis who had tailored dose-reduction of tumor necrosis factor-alpha blocking agents showed low disease activity after 24 months, according to study findings.

Patient data were gathered from the Groningen Leeuwarden Ankylosing Spondylitis (GLAS) prospective, longitudinal, observational study. Researchers selected 58 patients with ankylosing spondylitis (AS) and stable, low disease activity being treated with a biologic agent. Mean patient age was 45 years, and 91% of the patients were men. Patients were enrolled between June 2005 and March 2011, and median disease duration was 18 years.

Patients began a dose reduction of Enbrel (etanercept, Amgen), infliximab or Humira (adalimumab, AbbVie), at the time of which median Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) was 1.5 and Ankylosing Spondylitis Disease Activity Score (ASDAS) was 1.4, down from a mean 5.8 BASDAI and 3.7 ASDAS at the beginning of treatment.

Dose reduction involved tapering the dose and/or extending the interval between doses, as well as tailoring the dose individually to the patient based on BASDAI score and physician and patient preferences.

After 6, 12, 18 and 24 months, 43, 36, 33, and 31 patients, respectively, remained on the reduced dose. Of the 31 patients who continued at a reduced dose, 21 remained on the same initial reduced dose, according to the researchers. Four patients attempted to further reduce the dose but returned to the initial reduced dose, and two increased dosage frequency without returning to the conventional dose. Mean dose of therapy after 24 months was 62% of the conventional dosage.

The only predictors of response to treatment with a lower dose was higher AS quality-of-life scores prior to reduction, according to the researchers. by Shirley Pulawski

Disclosures: Arends reports the receipt of research grants from Abbott, Pfizer and Wyeth. Please see the full study for a complete list of all other authors’ financial disclosures

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