Therapeutic efficacy and safety of multiple intravenous infusions of infliximab in refractory ankylosing spondylitis patients with axial involvement

Infliximab dose reduction sustains the clinical treatment effect in active HLAB27 positive ankylosing spondylitis: a two-year pilot study

The rationale of the study was to evaluate the efficacy of infliximab (IFX) treatment in patients with ankylosing spondylitis (AS) and to determine whether IFX dose reduction and interval extension sustains the treatment effect. Nineteen patients were included and treated with IFX 5 mg/kg every 6 weeks for 56 weeks. All patients concomitantly received MTX with median dose 7.5 mg/weekly. During the second year, the IFX dose was reduced to 3 mg/kg every 8 weeks. Eighteen patients completed the 1-year and 15 patients the 2-year trial. The ≥50% improvement at week 16 from baseline of BASDAI was achieved in 16/19 (84%) patients. Significant reductions in BASDAI, BASFI, and BASMI scores, decrease in ESR and CRP, and improvement in SF-36 were observed at weeks 16 and 56. The MRI-defined inflammatory changes in the sacroiliac joints disappeared in 10/15 patients (67%) already at 16 weeks. IFX treatment effect was sustained throughout the second year after IFX dose reduction and interval extension. We conclude that IFX treatment is effective in well-established active AS and a dose reduction sustains the treatment effect. These observations are of clinical importance and open the opportunity to reduce the drug costs. This trial is registered with ClinicalTrials.gov NCT01850121.

Increased efficacy of infliximab associated with methotrexate in ankylosing spondylitis

OBJECTIVES

The aims of this study were to assess the efficacy of infliximab (IFX) combined with methotrexate (MTX) versus IFX alone in the treatment of ankylosing spondylitis (AS).

METHODS

The study was a 30weeks open label and prospective study of parallel groups in 19 patients with active AS. These patients had shown incomplete therapeutic response to standard therapy (full dose of non-steroidal anti-inflammatory drugs: NSAIDs) and disease modifying antirheumatic drugs: DMARDs (MTX or sulfasalazine: SLZ) for a period of at least 12 weeks and were treated with IFX (5mg/kg). Patients were divided into two treatment groups according to the previous treatment: in Group A, 9 patients previously treated with 7.5mg/week of MTX were treated with IFX in addition to MTX (IFX+MTX); in Group B, 10 patients previously treated only with NSAIDs were treated with IFX (5mg/kg) as monotherapy (IFX). The primary outcome was improvement in disease activity shown by the BASDAI50 at week 30; the secondary outcome included comparison of the proportions of subjects in each group achieving response criteria proposed by the ASAS group. BASDAI, BASFI, ESR, CRP, pain, inflammation and Patient Global Assessment were also recorded.

RESULTS

Both groups were similar in sex ratio, clinical forms and B27. Differences between groups occurred only in the disease duration and age of the patient. At 14 and 30 weeks only 50% and 10% respectively of the patients from the IFX group achieved BASDAI50 response compared to 89% of patients from the IFX+MTX group. The difference between groups at 30 weeks was statistically significant (p=0.001; percentage of difference: 79%; 95% confidence interval (CI): 26-93%:). ASAS50 was reached in 67% and 55.6% of patients from the IFX+MTX group at 14 and 30 weeks respectively, compared with 30% and 0% of patients from the IFX group The difference between groups at 30 weeks was statistically significant (p=0.011; percentage of difference: 57%; 95% CI: 8-84.7%).

CONCLUSION

Infliximab in combination with MTX seems to increase the efficacy of the therapeutic response in active AS patients, but more wide-ranging studies are necessary, mainly long-term studies.