Clin Orthop Surg.  2010 Mar;2(1):28-33. 10.4055/cios.2010.2.1.28.

Anti-TNF-alpha Therapy for Ankylosing Spondylitis

• Son JH
• Cha SW

• KMID: 1110346
• DOI: http://doi.org/10.4055/cios.2010.2.1.28

Abstract

BACKGROUND: This review evaluated the safety and efficacy of etanercept in patients with ankylosing spondylitis (AS).
METHODS
Of 59 patients with AS, this study reviewed 11 patients who were refractory to conventional therapy and treated with etanercept from September 2005 to January 2008. The mean follow-up duration was 13.6 months. The general improvement was evaluated by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and adverse effects, complications and inflammatory markers were also assessed.
RESULTS
The mean BASDAI decreased from 7.1 +/- 1.6 before treatment to 4.2 +/- 1.8 at 3 months after the etanercept treatment (p = 0.001). The mean erythrocyte sedimentation rate and C-reactive protein were decreased significantly by the etanercept treatment. The greatest improvement in symptoms was enthesitis, followed by skin involvement and morning stiffness. There was a significant difference in the improvement in BASDAI along with the follow up duration (p = 0.04). A serious infection was observed as a complication in 1 case.
CONCLUSIONS
These results suggest that etanercept can induce significant improvement in most patients with less damage. A trial of tumor necrosis factor inhibition is indicated in all AS patients who do not achieve adequate disease control with disease-modifying antirheumatic drugs, such as methotrexate, leflunomide etc. The patients treated with etanercept should be educated about the possibility of infection and monitored closely.

Keyword

Tumor necrosis factor-alpha; Etanercept; Ankylosing spondylitis

MeSH Terms

Adult
Anti-Inflammatory Agents, Non-Steroidal/*administration & dosage/adverse effects
Antirheumatic Agents/*administration & dosage/adverse effects
Blood Sedimentation
C-Reactive Protein/analysis
Drug Administration Schedule
Female
Humans
Immunoglobulin G/*administration & dosage/adverse effects
Injections, Subcutaneous
Male
Middle Aged
Receptors, Tumor Necrosis Factor/*administration & dosage
Spondylitis, Ankylosing/diagnosis/*drug therapy
Tumor Necrosis Factor-alpha/*antagonists & inhibitors
Young Adult

Figure

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  Fig. 1 Mean Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores of the patients who received etanercept at wk 0, 12. The mean BASDAI scores decreased from the baseline (p = 0.001).

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  Fig. 2 Disease activity indicator (erythrocyte sedimentation rate [ESR]); ESR at 0, 3, 6, 12 mo decreased significantly (p = 0.051).

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  Fig. 3 Disease activity indicator C-reactive protein (CRP); CRP at 0, 3, 6, 12 mo decreased significantly (p = 0.045).

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