Aktywność choroby w spondyloartropatii osiowej po przerwie w leczeniu inhibitorem TNF
Data nadesłania: 06-04-2017
Data ostatniej rewizji: 08-07-2017
Data akceptacji: 02-08-2017
Data publikacji online: 31-08-2017
Data publikacji: 31-08-2017
Reumatologia 2017;55(4):157-162
Objective: Use of tumour necrosis factor inhibitors (TNFi) has proved to be an important step forward in the treatment of axial spondyloarthritis (axSpA), but the duration of the therapy as well as the management in case of low disease activity (LDA) or remission are not clearly established. Currently, the identification of potential predictors associated with the treatment discontinuation is the basic purpose of many clinical studies. The aim of this study was to analyze the influence of the discontinuation of TNFi therapy on the disease activity in patients with low disease activity.
Material and methods: The study included 65 patients; 47 of patients (72%) were treated with etanercept, 16 (2%) with adalimumab and 2 (3%) with infliximab.
Results: The mean age of the patients was 45 years, the mean BASDAI score was 6.8 and VAS for low back pain was 76 mm at baseline. 54 patients with axSpA (83%) achieved LDA after 9 months of anti-TNF therapy. During follow-up 40 patients (74% of patients with LDA) had an increase of the disease activity after mean 14 weeks and needed to restart the treatment with TNFi. After restart of the therapy LDA was regained in all patients after mean 7 weeks. 11 patients (17%) have never achieved LDA and 14 patients (22%) had LDA longer than 6 months without relapse. At baseline higher levels of CRP and ESR were observed in patients with relapse of the disease at the end of treatment and with LDA shorter than 6 months.
Conclusions: Changes in the values of disease activity indicators (CRP, ESR) correlated with more stable response to TNFi therapy. Over 50% of patients who were treated with TNFi needed to restart the therapy. Treatment resumption allowed to regain a good clinical effect among affected patients.
Akkoc N, Khan MA. ASAS classification criteria for axial spondyloarthritis: time to modify. Clin Rheumatol 2016; 35:1415-1423.
François RJ, Gardner DL, Degrave EJ, et al. Histopathologic evidence that sacroiliitis in ankylosing spondylitis is not merely enthesitis. Arthritis Rheum 2000; 43: 2011-2024.
Wu W, Ding Y, Chen Y, et al. Susceptibility to ankylosing spondylitis: evidence for the role of ERAP1, TGFb1 and TLR9 gene polymorphisms. Rheumatol Int 2012; 32: 2517-2521.
Braun J, van den Berg R, Baraliakos X, et al. 2010 update of the ASAS/EULAR recommendations for the management of ankylosing spondylitis. Ann Rheum Dis 2011; 70: 896-904.
van der Heijde D, Ramiro S, Landewe R, et al. 2016 update of the ASAS-EULAR management recommendations for axial spondyloarthritis. Ann Rheum Dis 2017; 76: 978-991.
Garrett S, Jenkinson T, Kennedy LG, et al. A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol 1994; 21: 2286-2291.
Brandt J, Haibel H, Cornely D, et al. Successful treatment of active ankylosing spondylitis with the anti-TNF- monoclonal antibody infliximab. Arthritis Rheum 2000; 43: 1346-1352.
Machado P, Navarro-Compán V, Landewé R, et al. How to calculate the ASDAS if the conventional CRP is below the limit of detection or if using high sensitivity CRP? An analysis in the DESIR cohort. Arthritis Rheum 2015; 67: 408-413.
Salaffi F, Ciapetti A, Carotti M, et al. Construct validity and responsiveness of the simplified version of Ankylosing Spondylitis Disease Activity Score (SASDAS) for the evaluation of disease activity in axial spondyloarthritis. Health Qual Life Outcomes 2014; 12: 129.
Arends S, Brouwer E, Efde M, et al. Long-term drug survival and clinical effectiveness of etanercept treatment in patients with ankylosing spondylitis in daily clinical practice. Clin Exp Rheumatol 2017; 35: 61-68.
Lee W, Reveille JD, Davis JC J, et al. Are there gender differences in severity of ankylosing spondylitis? Results from the PSOAS cohort. Ann Rheum Dis 2007; 66: 633-638.
Maas F, Arends S, Brouwer E, et al. Reduction in spinal radiographic progression in ankylosing spondylitis patients receiving prolonged treatment with TNF- inhibitors. Arthritis Care Res 2016; doi: 10.1002/acr.23097.
Braun J, Deodhar A, Dijkmans B, et al. Efficacy and safety of infliximab in patients with ankylosing spondylitis over a two-year period. Arthritis Rheum 2008; 59: 1270-1278.
Davis JC, Van Der Heijde D, Braun J, et al. Recombinant human tumor necrosis factor receptor (etanercept) for treating ankylosing spondylitis: a randomized, controlled trial. Enbrel Ankylosing Spondylitis Study Group. Arthritis Rheum 2003; 48: 3230-3236.
van der Heijde DM, Revicki DA, Gooch KL, et al. Physical function, disease activity, and health-related quality-of-life outcomes after 3 years of adalimumab treatment in patients with ankylosing spondylitis. ATLAS Study Group. Arthritis Res Ther 2009; 11: 124.
Braun J, Sieper J. Remission and possible discontinuation of biological therapy in axial spondyloarthritis. Clin Exp Rheumatol 2013; 31: 33-36.
Kang K, Kwok SK, Ju J, et al. The predictors of development of new syndesmophytes in female patients with ankylosing spondylitis. Scand J Rheumatol 2015; 44: 125-128.
Ramiro S, van der Heijde D, van Tubergen A, et al. Higher disease activity leads to more structural damage in the spine in ankylosing spondylitis: 12-year longitudinal data from the OASIS cohort. Ann Rheum Dis 2014; 73: 1455-1461.
Baraliakos X, Listing J, Fritz C, et al. Persistent clinical efficacy and safety of infliximab in ankylosing spondylitis after 8 years – early clinical response predicts long-term outcome. Rheumatology 2011; 50: 1690-1699.
Baraliakos X, Haibel H, Fritz C, et al. Long-term outcome of patients with active ankylosing spondylitis with etanercept-sustained efficacy and safety after seven years. Arthritis Res Ther 2013; 15: 67.
Song IH, Haibel H, Poddubnyy D, et al. Withdrawal of biologic therapy in axial spondyloarthritis: the experience in early disease. Clin Exp Rheumatol 2013; 31: 37-42.
Pincus T, Braun J, Kavanaugh A, et al. Possible discontinuation of therapies in inflammatory rheumatic diseases – as with initiation of therapies, a shared decision between patient and rheumatologist. Clin Exp Rheumatol 2013; 31: 1-3.
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