More than half of patients in AS remission relapse after ceasing infliximab
Approximately 58% of patients in clinical remission after taking infliximab for ankylosing spondylitis relapse within 12 months after discontinuing the treatment, according to data published in Arthritis Research & Therapy.
“The introduction of biological therapy has undoubtedly been an important step forward in improving the quality of life, activity, functionality, metrology, and most extra-articular manifestations in patients with AS and other forms of spondyloarthropathy,” Mireia Moreno, MD, of the Hospital Parc Taulí de Sabadell, at the Autonomous University of Barcelona, and colleagues wrote. “Around 60% of patients treated with an anti-TNF achieve a good clinical response; however, according to the Assessment of Spondyloarthritis International Society (ASAS), only 20% to 30% achieve criteria of clinical partial remission in which the patient is apparently asymptomatic.”
“Since anti-TNF treatment also presents drawbacks, such as its high cost and the possibility of long-term side effects, it seems reasonable to plan a time-limited treatment for some patients,” they added.
To determine how long patients with AS who had achieved remission could remain flare-free after discontinuing anti-TNF treatment, specifically infliximab (Remicade, Janssen), as well as to analyze the impact of drug reintroduction, Moreno and colleagues conducted a multicenter, prospective observational study of patients in Catalonia, Spain. Participants included adults with AS, with a disease duration of more than 1 year, who met the criteria for anti-TNF treatment at 23 hospitals with rheumatology services.
The researchers enrolled 107 patients, of whom 36 achieved clinical remission lasting at least 6 months after treatment with infliximab. These 36 participants were included in the study’s final analysis. Moreno and colleagues collected data on each included patient at baseline and subsequently every 6 to 8 weeks during a total study period of 12 months. Data included information on patient age, gender, disease duration, peripheral arthritis or enthesitis, HLA-B27 status, Bath Ankylosing Spondylitis Disease Activity Index, C-reactive protein, erythrocyte sedimentation rate, Bath Ankylosing Spondylitis Functional Index, visual analogue scales, spine global pain, spinal night-time pain and patient’s global assessment.
According to the researchers, 21 of the 36 patients who had achieved remission experienced relapse after treatment withdrawal. When infliximab was reintroduced in relapsing patients, just 52% achieved remission again, and an additional 10% failed to respond at all to the treatment; these patients received a different TNF inhibitor. The researchers found no clinical or biological factors associated with relapse during follow-up period.
“This is the first prospective trial performed in a homogeneous cohort of AS patients to evaluate the effect of anti-TNF withdrawal in patients presenting persistent clinical remission,” Moreno and colleagues wrote. “Our data of clinical relapse during the first 12months in the majority of patients in AS patients are in agreement with the study in non-radiographic [axial spondyloarthritis] previously published. Moreover, although the reintroduction of infliximab treatment was safe, half of the patients did not achieve the same clinical response as prior to treatment withdrawal.” – by Jason Laday
Disclosure: The researchers report no relevant financial disclosures.