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Cytokine correlates of clinical response patterns to infliximab treatment of ankylosing spondylitis
  1. M A Stone1,
  2. U Payne2,
  3. C Pacheco-Tena1,
  4. R D Inman1
  1. 1Department of Medicine and Division of Rheumatology, University of Toronto; Toronto Western Hospital Research Institute, Toronto, Ontario, Canada
  2. 2Toronto Western Hospital Research Institute, Toronto, Ontario, Canada
  1. Correspondence to:
    Dr R D Inman
    Arthritis Centre of Excellence, Toronto Western Hospital, 399 Bathurst St, Toronto, Canada M5T 2S8;


Objective: To identify clinical and immunological markers of response to treatment with infliximab in ankylosing spondylitis (AS).

Methods: Baseline and sequential cytokine levels (IL1, TNFα, IFNγ, TGFβ and IL10) were examined after 52 weeks of infliximab treatment 5 mg/kg in 22 patients.

Results: At week 52, 18 patients were responders and four non-responders according to ASAS group criteria. Clinical measures of disease activity between the two groups at baseline were similar, apart from a trend towards longer disease duration in non-responders (p = 0.08). Baseline CRP and TNFα levels were higher in responders than non-responders (p<0.01 and p<0.006, respectively). The two groups had similar baseline cytokine levels, apart from TNFα. Baseline CRP levels did not correlate significantly with baseline cytokine levels in responders, but a strong correlation was noted between baseline CRP and IL1, IFNγ, and IL10 in non-responders. Apart from an early rise in TGFβ and a decrease in IL10 in responders after the first infusion, sequential cytokine analysis for the first six months of treatment was not related to clinical disease activity measures.

Conclusion: Although sequential cytokine analysis does not appear to be informative, baseline CRP and TNFα levels are useful markers of clinical response patterns in patients with AS treated with infliximab.

  • ankylosing spondylitis
  • infliximab
  • tumour necrosis factor α
  • cytokines
  • C reactive protein
  • ANOVA, analysis of variance
  • AS, ankylosing spondylitis
  • ASAS, AS Assessment Study
  • BASDAI, Bath AS Disease Activity Index
  • BASFI, Bath AS Spondylitis Index
  • CRP, C reactive protein
  • DMARD, disease modifying antirheumatic drug
  • ELISA, enzyme linked immunosorbent assay
  • ESR, erythrocyte sedimentation rate
  • IFNγ, interferon γ
  • IL, interleukin
  • NSAID, non-steroidal anti-inflammatory drug
  • PBMC, peripheral blood mononuclear cells
  • SpA, spondyloarthropathy
  • TGFβ, transforming growth factor β
  • TNFα, tumour necrosis factor α
  • VAS, visual analogue scale

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