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Persistent clinical efficacy and safety of anti-TNFα therapy with infliximab in patients with ankylosing spondylitis over 5 years - evidence for different types of response
  1. J Braun (j.braun{at}
  1. Rheumazentrum Ruhrgebiet, Germany
    1. X Baraliakos (xenob{at}
    1. Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Germany
      1. J Listing (listing{at}
      1. German Rheumatism Research Centre, Germany
        1. C Fritz (fritz{at}
        1. German Rheumatism Research Centre, Germany
          1. R Alten (rieke.alten{at}
          1. Schlosspark-Clinic, Germany
            1. G Burmester (gerd.burmester{at}
            1. Charite University Hospital, Germany
              1. A Krause (a.krause{at}
              1. Immanuel-Krankenhaus Rheumaklinik Wannsee, Germany
                1. S Schewe
                1. LMU München, Rheumatology, Germany
                  1. M Schneider (schneider{at}
                  1. Heinrich-Heine-University, Düsseldorf, Germany
                    1. H Soerensen
                    1. Rheumatology Praxis, Berlin, Germany
                      1. H Zeidler
                      1. Medical University Hannover, Germany
                        1. J Sieper (joachim.sieper{at}
                        1. University Clinic Benjamin Franklin, Germany


                          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.

                          • TNFalpha
                          • ankylosing spondylitis
                          • infliximab
                          • response types

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