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Persistent clinical efficacy and safety of anti-tumour necrosis factor therapy with infliximab in patients with ankylosing spondylitis over 5 years: evidence for different types of response

¹ Rheumatology Medical Center Ruhrgebiet, Herne
² German Rheumatism Research Center, Berlin
³ Schlosspark Clinic, Berlin
⁴ Charité Hospital, Humboldt University, Berlin
⁵ Berlin-Buch Hospital, Berlin
⁶ Ludwig-Maximilians-University, Munich
⁷ Heinrich-Heine-University, Düsseldorf
⁸ Immanuel Hospital, Berlin
⁹ Medical University, Hannover
¹⁰ University Medicine Berlin, Campus Benjamin Franklin, all Germany

Correspondence to:
Prof.Dr. J Braun, Rheumazentrum Ruhrgebiet, Landgrafenstr. 15, 44652 Herne, Germany; j.braun{at}rheumazentrum-ruhrgebiet.de

Background: There is insufficient evidence for the long-term efficacy and safety of anti-tumour necrosis factor therapy in patients with ankylosing spondylitis (AS). This is the first report on the treatment with infliximab over 5 years.

Methods: As part of a multicentre randomised trial, 69 patients with active AS at baseline (BL) have been continuously treated with infliximab (5 mg/kg i.v. every 6 weeks)—except for a short discontinuation after 3 years (FU1). The primary outcome of this extension was remission according to the ASsessment in Ankylosing Spondylitis (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 of 38 patients (34.2%) at FU1 and FU2. At FU2, the mean Bath Ankylosing Spondylitis Disease Activity Index (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, as all but one patient achieved an ASAS 20% response at least once within the last 2 years. Three types of responders were identified. No major side effects occurred during years 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.