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Frequency and duration of drug-free remission after 1 year of treatment with etanercept versus sulfasalazine in early axial spondyloarthritis: 2 year data of the ESTHER trial
  1. In-Ho Song1,
  2. Christian E Althoff2,
  3. Hildrun Haibel1,
  4. Kay-Geert A Hermann2,
  5. Denis Poddubnyy1,
  6. Joachim Listing3,
  7. Anja Weiß3,
  8. Svetlana Djacenko4,
  9. Gerd R Burmester5,
  10. Martin Bohl-Bühler6,7,
  11. Bruce Freundlich8,
  12. Martin Rudwaleit1,
  13. Joachim Sieper1,3
  1. 1Department of Rheumatology, Charité Medical University, Campus Benjamin-Franklin, Berlin, Germany
  2. 2Department of Radiology, Charité Medical University, Campus Mitte, Berlin, Germany
  3. 3Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
  4. 4Department of Rheumatology, Schlossparkklinik, Berlin, Germany
  5. 5Department of Rheumatology and Clinical Immunology, Charite University Hospital, Berlin, Germany
  6. 6Department of Rheumatology, Private Practice, Potsdam, Germany
  7. 7Endokrinologikum Berlin, Private Practice, Berlin, Germany
  8. 8Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  1. Correspondence to Joachim Sieper, Charité, Department of Rheumatology, Campus Benjamin Franklin, Med. Clinic I, Rheumatology, Hindenburgdamm 30, 12200 Berlin, Germany; joachim.sieper{at}


Purpose The aims of this study were (1) to assess the frequency and duration of drug-free remission and efficacy of etanercept (ETA) treatment after flare in patients with early active axial spondyloarthritis who were treated with ETA (n=40) versus sulfasalazine (SSZ, n=36) for 48 weeks and (2) to analyse the efficacy of ETA treatment in patients in year 2 who did not reach remission at week 48.

Method At week 48, patients who reached study remission (Assessment of Spondyloarthritis international Society (ASAS) plus MRI remission) were followed up without active treatment up to 1 year. In case of a flare, patients were treated with ETA for another year. All patients who were not in ASAS plus MRI remission at week 48 were treated with ETA in year 2.

Results ASAS plus MRI remission at week 48 was reached significantly more often in ETA-treated compared to SSZ-treated patients (33% vs 11%, p=0.03). However, the flare rate was not different between these two groups: 69% in the ETA group versus 75% in the SSZ group. Only 8% of patients initially treated with ETA versus 3% of those initially treated with SSZ reached permanent drug-free remission (not significant). After treatment with ETA over 1 year, patients with flare showed an improvement in all clinical and imaging variables.

Conclusion Patients with axial spondyloarthritis treated with ETA over 1 year did not reach drug-free remission in a higher percentage compared to patients from a control group treated with SSZ.

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  • Funding This study was supported by Wyeth/Pfizer.

  • Competing interests IS, HH, DP: Pfizer/Wyeth Pharmaceuticals, Merck Sharp Dohme/Schering Plough, Abbott Immunology Pharmaceuticals: consulting fees or other remuneration. GB, MB, MR and JS: Pfizer/Wy eth Pharmaceuticals, Merck Sharp Dohme/Schering Plough, Abbott Immunology Pharmaceuticals, UCB: consulting fees or other remuneration. BF: Former employee of Pfizer/Wyeth. CA, KGH, JL, AW, SD: none.

  • Ethics approval Ethics approval was granted by Landesamt für Gesundheit und Soziales, Geschäftsstelle der Ethik-Kommission des Landes, Berlin, Germany.

  • Provenance and peer review Not commissioned; externally peer reviewed.