Infliximab treatment in ankylosing spondylitis: an observational study

Nikas, Spyros N.; Alamanos, Yannis; Voulgari, Paraskevi V.; Pliakou, Xanthi; Papadopoulos, Christos; Drosos, Alexandros A.

doi:10.1136/ard.2004.029900

Cited by 33 publications

(11 citation statements)

References 12 publications

(15 reference statements)

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“…Although methotrexate is frequently recommended, there is no evidence that it is beneficial in axial arthropathy. The antitumor necrosis factor (anti-TNF) agents infliximab and etanercept have been reported to be effective in treating AS, [26][27][28][29] although sustained response could be maintained only with continued long-term therapy with these agents. Treatment with anti-TNF agents is recommended when patients do not respond adequately to NSAIDs given for at least 3 months.…”

Section: Peripheral and Axial Arthropathymentioning

confidence: 99%

Extraintestinal Manifestations of Inflammatory Bowel Diseases

Kethu¹

2006

Journal of Clinical Gastroenterology

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Inflammatory bowel diseases are associated with extraintestinal manifestations involving almost every organ system in the body. They occur in approximately 20% to 40% of patients with inflammatory bowel diseases. Immune-related and genetic mechanisms play an important role in the pathogenesis of these complications. Peripheral arthritis, erythema nodosum, and episcleritis respond to the treatment of the underlying intestinal inflammation, whereas axial arthropathy, pyoderma gangrenosum, and uveitis do not. Immunomodulator therapy, particularly with biologic agents has been shown to be effective in treating some of the extraintestinal manifestations. Early recognition and treatment are crucial in preventing major morbidity.

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Section: Peripheral and Axial Arthropathymentioning

confidence: 99%

Extraintestinal Manifestations of Inflammatory Bowel Diseases

Kethu¹

2006

Journal of Clinical Gastroenterology

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“…Infliximab has been shown to be clinically effective in ankylosing spondylitis [18][19][20][21][22][23][24][25][26][27][28][29][30]; however, its structuremodifying activity in ankylosing spondylitis has only been demonstrated recently. Baraliakos et al [40] evaluated radiographic progression in the cervical and lumbar spine in ankylosing spondylitis subjects treated with either infliximab or conventional therapy (see Table 1 [ 30,38,40,41 ,42-45,46 ]).…”

Section: Infliximabmentioning

confidence: 99%

New therapeutic approaches for spondyloarthritis

Manadan

James²,

Block³

2007

Current Opinion in Rheumatology

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Despite insufficient evidence to conclude definitively that tumor necrosis factor alpha-antagonist therapy provides durable and effective structure modification in ankylosing spondylitis, the data strongly suggest a benefit, at least in the short term. In the future, MRI data coupled with clinical outcomes in larger cohorts followed for longer durations may result in a paradigm shift for ankylosing spondylitis treatment similar to that undergone for rheumatoid arthritis, where patients with ankylosing spondylitis are offered therapy early in the disease course to arrest and prevent structural disease progression.

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“…64 The onset of clinical effect with TNF blockers is rapid, 59 and therapeutic effect persists for up to 3 years with continuing treatment. [65][66][67][68] Stopping treatment results in a high proportion of patients with clinical relapse. 69 Although adding methotrexate to infliximab treatment in rheumatoid arthritis improves clinical outcome 70 and reduces side effects, 71 there has been no evidence to support any additional benefit with concomitant methotrexate use in AS.…”

mentioning

confidence: 99%

ASAS/EULAR recommendations for the management of ankylosing spondylitis

Zochling

2006

Annals of the Rheumatic Diseases

611

315

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Objective: To develop evidence based recommendations for the management of ankylosing spondylitis (AS) as a combined effort of the 'ASsessment in AS' international working group and the European League Against Rheumatism. Methods: Each of the 22 participants was asked to contribute up to 15 propositions describing key clinical aspects of AS management. A Delphi process was used to select 10 final propositions. A systematic literature search was then performed to obtain scientific evidence for each proposition. Outcome data for efficacy, adverse effects, and cost effectiveness were abstracted. The effect size, relative risk, number needed to treat, and incremental cost effectiveness ratio were calculated. On the basis of the search results, 10 major recommendations for the management of AS were constructed. The strength of recommendation was assessed based on the strength of the literature evidence, risk-benefit trade-off, and clinical expertise. Results: The final recommendations considered the use of non-steroidal anti-inflammatory drugs (NSAIDs) (conventional NSAIDs, coxibs, and co-prescription of gastroprotective agents), disease modifying antirheumatic drugs, treatments with biological agents, simple analgesics, local and systemic steroids, non-pharmacological treatment (including education, exercise, and physiotherapy), and surgical interventions. Three general recommendations were also included. Research evidence (categories I-IV) supported 11 interventions in the treatment of AS. Strength of recommendation varied, depending on the category of evidence and expert opinion. Conclusion: Ten key recommendations for the treatment of AS were developed and assessed using a combination of research based evidence and expert consensus. Regular updating will be carried out to keep abreast of new developments in the management of AS.A nkylosing spondylitis (AS) is a chronic, inflammatory rheumatic disease characterised by inflammatory back pain due to sacroiliitis and spondylitis, the formation of syndesmophytes leading to ankylosis, and frequently associated with peripheral arthritis, enthesitis, and acute anterior uveitis. Symptoms commonly begin in late adolescence and early adulthood.1 2 With an estimated prevalence of 0.9% in northern European white populations 3 AS is a significant health burden to the community.AS has long been a therapeutic challenge for the clinician. Exercise and non-steroidal anti-inflammatory drugs (NSAIDs) have been the mainstay of symptom control for decades, but there has until recently been a dearth of disease modifying treatments. The advent of biological treatment is currently revolutionising the management of AS, but too little is known yet about the long term benefits and risks of such treatment. Clearly, these treatments necessitate socioeconomic cost calculations. Moreover, there is a need for rational, evidence based recommendations to guide the physician in the management of AS. The ASsessment in AS (ASAS) international working group has made important contributions to the eval...

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Infliximab treatment in ankylosing spondylitis: an observational study

Cited by 33 publications

References 12 publications

Extraintestinal Manifestations of Inflammatory Bowel Diseases

Extraintestinal Manifestations of Inflammatory Bowel Diseases

New therapeutic approaches for spondyloarthritis

ASAS/EULAR recommendations for the management of ankylosing spondylitis

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