TY - JOUR
T1 - Withdrawal of infliximab therapy in ankylosing spondylitis in persistent clinical remission, results from the REMINEA study
AU - Moreno, Mireia
AU - Gratacós, Jordi
AU - Torrente-Segarra, Vicenç
AU - Sanmarti, Raimon
AU - Morlà, Rosa
AU - Pontes, Caridad
AU - Llop, Maria
AU - Juanola, Xavier
AU - Rodriguez-De-La-Serna, Arturo
AU - Hernandez, Victoria
AU - Riera, Elena
AU - Ortiz, Vera
AU - Clavaguera, Teresa
AU - Reyner, Patricia
AU - Sala, Miquel
AU - Sellas, Agustí
AU - Pitarch, Concepció
AU - Reina, Delia
AU - Blanco, Jordi
AU - Centelles, Montse
AU - Figuls, Ramon
AU - Gelman, Mario
AU - Arasa, Xavier
AU - Bonet, Maria
AU - Ciria, Manel
PY - 2019/4/5
Y1 - 2019/4/5
N2 - © 2019 The Author(s). Background: Recent data suggest that anti-TNF doses can be reduced in ankylosing spondylitis (AS) patients. Some authors even propose withdrawing treatment in patients in clinical remission; however, at present there is no evidence to support this. Objective: To assess how long AS patients with persistent clinical remission remained free of flares after anti-TNF withdrawal and to evaluate the effects of treatment reintroduction. We also analyze the characteristics of patients who did not present clinical relapse. Methods: Multicenter, prospective, observational study of a cohort of patients with active AS who had received infliximab as a first anti-TNF treatment and who presented persistent remission (more than 6 months). We recorded at baseline and every 6-8 weeks over the 12-month period the age, gender, disease duration, peripheral arthritis or enthesitis, HLA-B27 status, BASDAI, CRP, ESR, BASFI, and three visual analogue scales, spine global pain, spinal night time pain, and patient's global assessment. Results: Thirty-six out of 107 patients (34%) presented persistent remission and were included in our study. After treatment withdrawal, 21 of these 36 patients (58%) presented clinical relapse during follow-up. Infliximab therapy was reintroduced and only 52% achieved clinical remission, as they had before the discontinuation of infliximab; in an additional 10%, reintroduction of infliximab was ineffective, obliging us to change the anti-TNF therapy. No clinical or biological factors were associated with the occurrence of relapse during the follow-up. Conclusions: Two thirds of patients in clinical remission presented clinical relapse shortly after infliximab withdrawal. Although the reintroduction of infliximab treatment was safe, half of the patients did not present the same clinical response that they had achieved prior to treatment withdrawal.
AB - © 2019 The Author(s). Background: Recent data suggest that anti-TNF doses can be reduced in ankylosing spondylitis (AS) patients. Some authors even propose withdrawing treatment in patients in clinical remission; however, at present there is no evidence to support this. Objective: To assess how long AS patients with persistent clinical remission remained free of flares after anti-TNF withdrawal and to evaluate the effects of treatment reintroduction. We also analyze the characteristics of patients who did not present clinical relapse. Methods: Multicenter, prospective, observational study of a cohort of patients with active AS who had received infliximab as a first anti-TNF treatment and who presented persistent remission (more than 6 months). We recorded at baseline and every 6-8 weeks over the 12-month period the age, gender, disease duration, peripheral arthritis or enthesitis, HLA-B27 status, BASDAI, CRP, ESR, BASFI, and three visual analogue scales, spine global pain, spinal night time pain, and patient's global assessment. Results: Thirty-six out of 107 patients (34%) presented persistent remission and were included in our study. After treatment withdrawal, 21 of these 36 patients (58%) presented clinical relapse during follow-up. Infliximab therapy was reintroduced and only 52% achieved clinical remission, as they had before the discontinuation of infliximab; in an additional 10%, reintroduction of infliximab was ineffective, obliging us to change the anti-TNF therapy. No clinical or biological factors were associated with the occurrence of relapse during the follow-up. Conclusions: Two thirds of patients in clinical remission presented clinical relapse shortly after infliximab withdrawal. Although the reintroduction of infliximab treatment was safe, half of the patients did not present the same clinical response that they had achieved prior to treatment withdrawal.
KW - Ankylosing spondylitis
KW - Anti-TNF therapy
KW - Disease activity
KW - Treatment withdrawal
UR - https://ddd.uab.cat/record/223399
U2 - https://doi.org/10.1186/s13075-019-1873-3
DO - https://doi.org/10.1186/s13075-019-1873-3
M3 - Article
C2 - 30953541
VL - 21
JO - Arthritis Research and Therapy
JF - Arthritis Research and Therapy
SN - 1478-6354
M1 - 88
ER -