Patient-tailored dose reduction of TNF-α blocking agents in ankylosing spondylitis patients with stable low disease activity in daily clinical practice

• Published in: Clinical and experimental rheumatology 2015-03, Vol.33 (2), p.174-180
• Main Authors: Arends, Suzanne, van der Veer, Eveline, Kamps, Fleur B S, Houtman, Pieternella M, Bos, Reinhard, Bootsma, Hendrika, Brouwer, Elisabeth, Spoorenberg, Anneke
• Format: Article
• Language: English
• Subjects: Adalimumab; Anti-Inflammatory Agents - administration & dosage; Antibodies, Monoclonal - administration & dosage; Antibodies, Monoclonal, Humanized - administration & dosage; Biological Products - administration & dosage; Clinical Protocols; Drug Dosage Calculations; Etanercept; Humans; Immunoglobulin G - administration & dosage; Infliximab; Longitudinal Studies; Netherlands; Prospective Studies; Receptors, Tumor Necrosis Factor - administration & dosage; Remission Induction; Severity of Illness Index; Spondylitis, Ankylosing - diagnosis; Spondylitis, Ankylosing - drug therapy; Spondylitis, Ankylosing - immunology; Time Factors; Treatment Outcome; Tumor Necrosis Factor-alpha - antagonists & inhibitors
• ISSN: 0392-856X

Tumour necrosis factor-alpha (TNF-α) blocking agents are very effective in controlling systemic inflammation and improving clinical assessments in ankylosing spondylitis (AS). In view of potential side effects and high costs of long-term treatment, our aim was to investigate whether dose reduction of TNF-α blocking agents is possible without loss of effectiveness in AS patients in daily clinical practice. Patients from the prospective observational GLAS cohort, fulfilling the modified New York criteria for AS, with active disease before start of TNF-α blocking therapy and stable (≥6 months) low disease activity on the conventional dose regimen, who started with dose reduction of TNF-α blocking therapy before June 2011 were studied. Dose reduction was patient-tailored (step-by-step approach) and consisted of lowering the dose and/or extending the interval between doses. Between June 2005 and March 2011, 58 AS patients started dose reduction of etanercept (n=39), infliximab (n=10), or adalimumab (n=9). Of all patients, 74%, 62%, and 53% maintained their reduced dose or dosing frequency after 6, 12, and 24 months, respectively. The mean dose of TNF-α blocking therapy over time corresponded to 62% of the standard dose regimen. Disease activity remained low in the majority of patients who maintained dose reduction after 24 months (94% had BASDAI