1. Withdrawal of infliximab therapy in ankylosing spondylitis in persistent clinical remission, results from the REMINEA study
- Author
-
Moreno Martínez-Losa, Mireia, Gratacós, Jordi, Torrente-Segarra, V., Sanmartí, Raimon, Morlà, R., Pontes, C., Llop, Maria, Juanola, Xavier, Rodriguez-De-La-Serna, A., Hernández Hernández, Vanesa, Riera, E., Ortiz, V., Clavaguera, T., Reyner, P., Sala, Miquel, Sellas, A., Pitarch, C., Reina, Delia, Blanco, J. (Joan), Centelles, M., Figuls, R., Gelman, M., Arasa, X., Bonet, Maria, Ciria, M., and Universitat Autònoma de Barcelona
- Subjects
Adult ,Male ,0301 basic medicine ,musculoskeletal diseases ,medicine.medical_specialty ,Treatment withdrawal ,lcsh:Diseases of the musculoskeletal system ,Espondiloartritis anquilosant ,Therapeutics ,Severity of Illness Index ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Clinical trials ,Recurrence ,Internal medicine ,medicine ,Humans ,Spondylitis, Ankylosing ,Disease activity ,BASDAI ,HLA-B27 Antigen ,030203 arthritis & rheumatology ,Ankylosing spondylitis ,Tumor Necrosis Factor-alpha ,business.industry ,Remission Induction ,Enthesitis ,Anti-TNF therapy ,Middle Aged ,medicine.disease ,Terapèutica ,Infliximab ,Rheumatology ,Discontinuation ,030104 developmental biology ,Withholding Treatment ,Antirheumatic Agents ,Cohort ,Female ,lcsh:RC925-935 ,medicine.symptom ,BASFI ,business ,Research Article ,medicine.drug ,Assaigs clínics - Abstract
Altres ajuts: This work is conducted under the umbrella of the Rheumatology Society of Catalonia and supported by Merck Research Laboratories. 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.
- Published
- 2019