Background Tumor necrosis factor-alpha (TNF-α) blocking agents are very effective in controlling inflammation and improving clinical assessments in patients with ankylosing spondylitis (AS).
Objectives In view of the high costs and possible side effects, 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.
Methods Patients included in the Groningen Leeuwarden AS (GLAS) cohort with active disease (Bath AS disease activity index (BASDAI)≥4) before start of anti-TNF-α treatment and stable (≥6 months) low disease activity (BASDAI<4) on conventional dose regime, who started with dose reduction were studied. Data concerning medication dose, reasons for changing medication dose, and disease activity were collected after 6, 12, 18, and 24 months of dose reduction.
Results Between November 2005 and January 2011, 49 AS patients with stable low disease activity started with dose reduction of infliximab (n=8), etanercept (n=35), or adalimumab (n=6). 88% of these patients were male, mean age was 46 years (SD±12), and mean duration of symptoms was 20 years (SD±10). Mean BASDAI was 1.8 (SD±1.1) at start of dose reduction, coming from 6.2 (SD±1.2) just before start of anti-TNF-α treatment.
In total, 71%, 54%, 47%, and 42% of the patients maintained on dose reduction after 6, 12, 18 and 24 months, respectively. The mean dose reduction was 37% (SD±11). Disease activity remained low (BASDAI<4) in 86% of the patients who continued dose reduction at 24 months (Table 1).
Conclusions In this observational cohort, long-term dose reduction of TNF-α blocking agents was possible preserving low disease activity in a substantial number of AS patients.
Disclosure of Interest None Declared
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