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my personal edition > rheumatology other > news
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DGReview
Disease Duration, Patient Age Among Factors Predicting Response To Tumour Necrosis Factor- Alpha in Ankylosing Spondylitis
A DGReview of :"Prediction of a major clinical response (BASDAI 50) to TNF-{alpha} blockers in ankylosing spondylitis"
Annals of the Rheumatic Diseases (ARD Online)
03/31/2004
By Kurt V. Ullman, RN
Shorter duration of disease, younger age and lower Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores are predictive of a major clinical response to tumour necrosis factor-alpha (TNF-alpha) medications in patients with active ankylosing spondylitis (AS), according to a study from Germany.
Raised levels of C-reactive protein (CRP) and higher BASDAI scores may also be useful predictors. If a response was recorded, it was usually seen during the first 6 weeks of treatment.
Dr. Martin Rudwaliet, from Charite-Universitatsmedizin in Berlin, Germany, and colleagues gathered data from 2 placebo-controlled, randomised trials - 69 patients with infliximab and 30 with etanercept. Diagnosis of AS was according to modified New York criteria and some active axial disease, defined as a BASDAI score of greater than or equal to 4 and a spinal pain score greater than or equal to 4, despite medication with non-steroidal anti-inflammatory drugs (NSAIDs). Major clinical response was defined as an improvement of 50% or more from the baseline BASDAI score (BASDAI 50). Participants were also assessed for functional problems using the Bath Ankylosing Spondylitis Functional Index (BASFI).
A significant decrease in the likelihood of achieving a major clinical response was found for each year of disease duration (OR= .93). When grouped into 3 blocks according to disease duration, 73% of those with disease duration less than or equal to 10 years had a BASDAI 50, compared to 58% of those between 11 and 20 years and 31% in those with disease duration of more than 20 years.
Significant decreases in achieving BASDAI 50 were also seen with increasing levels of BASFI. Patients with lower scores at baseline showed a higher rate of BASDAI 50 response.
There was clear correlation between a raised baseline CRP and a higher chance of achieving BADDAI 50. However, even by this measure, disease duration plays an important role. There was a significant difference in clinical response in those with short duration (5 years) and normal CRP when compared with those with a longer disease duration (25 years) and normal CRP (65% vs. 30% respectively). However, high levels of CRP increased the likelihood of a significant response in both groups (90% and 70%, respectively).
In those who significantly responded to treatment, an effect was seen quickly. After only 6 weeks of treatment, a BASDAI 50 score was already seen in 82% of those who would achieve BASDAI 50 by week 12. In addition, almost all responders at week 12 showed some improvement by the third week.
"High costs and possible (especially in the long term), although rare, side effects may argue for preselection of suitable patients in daily clinical practice," said the researchers. "An expected rate of 70% or more patients achieving an improvement of at 50% in their disease activity would certainly shift the benefit-risk ratio towards benefit."
Ann Rheum Dis 2004 Mar 22;[Epub ahead of print].
"Prediction of a major clinical response (BASDAI 50) to TNF-{alpha} blockers in ankylosing spondylitis"
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