Objective: To evaluate the long-term safety and efficacy of adalimumab in patients with ankylosing spondylitis (AS) with total spinal ankylosis (TSA).
Methods: Patients (N=315) with active AS were randomised in a 2:1 ratio to receive adalimumab 40 mg every other week or placebo for 24 weeks followed by open-label adalimumab for up to 5 years. Two-year efficacy and safety data for 11 patients with investigator-defined TSA were evaluated. The primary endpoint was the ASsessment in AS International Working Group 20% improvement (ASAS20) at Week 12. On or after Week 12, ASAS20 nonresponders could switch to open-label adalimumab. Other efficacy measurements included ASAS40, ASAS 5/6, ASAS partial remission, and 50% improvement in the Bath AS Disease Activity Index (BASDAI 50).
Results: Six of 11 TSA patients were randomised to adalimumab and five, to placebo. At Week 12, 50% of the adalimumab-treated patients achieved an ASAS20 response and 33% achieved an ASAS40, ASAS 5/6, and BASDAI 50. No placebo-treated patients achieved any response criteria at Week 12. Four placebo- and two adalimumab-treated patients switched to open-label adalimumab before Week 24. After 1 year of adalimumab treatment, eight of 11 patients achieved an ASAS20 response. After 2 years, six of the remaining eight patients with TSA reported an ASAS20 response. There were no serious adverse events or adverse event–related study discontinuations.
Conclusion: In patients with TSA, adalimumab treatment resulted in rapid and clinically significant improvement in the signs and symptoms of active disease. Adalimumab effectiveness and safety were sustained for at least 2 years.
- ankylosing spondylitis
- total spinal ankylosis
- tumour necrosis factor antagonist