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Sarilumab for the treatment of ankylosing spondylitis: results of a Phase II, randomised, double-blind, placebo-controlled study (ALIGN)
  1. Joachim Sieper1,
  2. Jürgen Braun2,
  3. Jonathan Kay3,
  4. Salvatore Badalamenti4,
  5. Allen R Radin5,
  6. Lixia Jiao4,
  7. Stefano Fiore4,
  8. Tanya Momtahen4,
  9. George D Yancopoulos5,
  10. Neil Stahl5,
  11. Robert D Inman6
  1. 1Med. Department 1, Rheumatology, Charité University Medicine Berlin, Berlin, Germany
  2. 2Rheumazentrum Ruhrgebiet, Herne, Germany
  3. 3Division of Rheumatology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
  4. 4Research and Development, Sanofi, Bridgewater, New Jersey, USA
  5. 5Translational Medicine, Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
  6. 6Division of Rheumatology, Toronto Hospital Western Division, Toronto, Canada
  1. Correspondence to Dr Joachim Sieper, Professor of Rheumatology, Charité Medical School, Department of Medicine 1, Campus Benjamin Franklin, Hindenburgdamm 30, Berlin 12200, Germany; joachim.sieper{at}


Objectives The ALIGN study (NCT01061723) evaluated the efficacy and safety of sarilumab, the first fully human monoclonal antibody against interleukin-6 receptor-α (IL-6Rα), in patients with ankylosing spondylitis (AS).

Methods Patients with active AS despite conventional treatment were randomised to placebo, or one of five subcutaneous dose regimens of sarilumab (100, 150 or 200 mg every other week, or 100 or 150 mg every week), for 12 weeks. The primary efficacy end point was the percentage of patients achieving the Axial SpondyloArthritis international Society (ASAS) 20 response criteria at week 12. Secondary endpoints included ASAS40 response, ASAS partial remission, AS Disease Activity Score, high-sensitivity C-reactive protein (hs-CRP) value, and safety.

Results Baseline demographic and disease characteristics of the 301 patients enrolled were similar across treatment groups. At week 12, there was no statistically significant difference in ASAS20 response rate between placebo (ASAS20 = 24.0%) and any sarilumab dose group. A significantly greater reduction in hs-CRP value was achieved with the higher sarilumab doses versus placebo. No other statistically significant differences were evident for secondary efficacy endpoints.

The most common treatment-emergent adverse events reported for sarilumab included infections (non-serious), neutropenia, and increase in alanine aminotransferase. No cases of tuberculosis, opportunistic, or fungal infections, or bowel perforations were reported. Seven patients experienced a treatment-emergent serious adverse event (all in sarilumab treatment groups). No deaths occurred.

Conclusions The ALIGN study shows that IL-6Rα blockade with sarilumab was not an effective treatment for AS. Sarilumab was generally well tolerated with a manageable safety profile.

  • Ankylosing Spondylitis
  • Cytokines
  • DMARDs (biologic)
  • Autoimmune Diseases
  • Inflammation

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