Background: There is insufficient evidence for the long-term efficacy and safety of anti-TNF therapy in patients with ankylosing spondylitis (AS). This is the first report on treatment with infliximab over 5 years.
Methods: As part of a multicener randomized trial, 69 patients with active AS at baseline (BL) have been continuously treated with infliximab (5mg/kg i.v./6w)-except for a short discontinuation after 3 years (FU1). The primary outcome of this extension was remission according to the ASAS criteria at the end of year 5 of the study (FU2).
Results: Of the 43 patients who completed year 3, 42 agreed to continue, 38 of which (90.5%) finished year 5 (55% of 69 initially). Partial clinical remission was achieved in 13/38 patients (34.2%) at FU1 and FU2. At FU2, the mean BASDAI was 2.5±1.9 (BL:6.4, FU1:2.5). BASDAI values <4 were seen in 79% of patients at both, FU1 and FU2. ASAS 20% and 40% responses were seen in 32 (84%) and 24 (63%) patients at FU2, respectively. Most patients classified as non-responders at FU2 were part time responders, since all but one patient achieved an ASAS20% response at least once within the last 2 years. Three types of responders were identified. No major side effects occurred during year 4 and 5 of infliximab therapy.
Conclusions: Infliximab is safe and efficacious in AS patients over 5 years. The majority of the patients remained on treatment and had rather persistent levels of low disease activity. Different response types could be identified.
- ankylosing spondylitis
- response types
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