Infliximab in ankylosing spondylitis: alone or in combination with methotrexate? A pharmacokinetic comparative study

Mulleman, Denis; Lauféron, Francine; Wendling, Daniel; Ternant, David; Ducourau, Émilie; Paintaud, Gilles; Goupille, Philippe

doi:10.1186/ar3350

Cited by 39 publications

(35 citation statements)

References 19 publications

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“…Because the effect of csDMARD is dependent on both the disease and individual TNFi agent, differences in these variables among different cohorts may explain observed discrepancies. Along with other studies 5 , we found no protective effect of MTX co-medication in AS; this finding is supported by smaller studies 17,18 . On the contrary, investigators from the Antirheumatic Therapies In Sweden registry reported a positive effect of MTX 10 .…”

Section: Rheumatologysupporting

confidence: 88%

Comparative Analysis and Predictors of 10-year Tumor Necrosis Factor Inhibitors Drug Survival in Patients with Spondyloarthritis: First-year Response Predicts Longterm Drug Persistence

Flouri

Markatseli²,

Boki³

et al. 2018

J Rheumatol

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Objective.To evaluate the 10-year drug survival of the first tumor necrosis factor inhibitor (TNFi) administered to patients with spondyloarthritis (SpA) overall and comparatively between SpA subsets, and to identify predictors of drug retention.Methods.Patients with SpA in the Hellenic Registry of Biologic Therapies, a prospective multicenter observational cohort, starting their first TNFi between 2004–2014 were analyzed. Kaplan-Meier curves and Cox regression models were used.Results.Overall, 404 out of 1077 patients (37.5%) discontinued treatment (followup: 4288 patient-yrs). Ten-year drug survival was 49%. In the unadjusted analyses, higher TNFi survival was observed in patients with ankylosing spondylitis (AS) compared to undifferentiated SpA and psoriatic arthritis [PsA; significant beyond the first 2.5 (p = 0.003) years and 7 years (p < 0.001), respectively], and in patients treated for isolated axial versus peripheral arthritis (p = 0.001). In all multivariable analyses, male sex was a predictor for longer TNFi survival. Use of methotrexate (MTX) was a predictor in PsA and in patients with peripheral arthritis. Absence of peripheral arthritis and use of a monoclonal antibody (as opposed to non-antibody TNFi) independently predicted longer TNFi survival in axial disease because of lower rates of inefficacy. Achievement of major responses during the first year in either axial or peripheral arthritis was the strongest predictor of longer therapy retention (HR 0.33, 95% CI 0.26–0.41 for Ankylosing Spondylitis Disease Activity Score inactive disease, and HR 0.35, 95% CI 0.24–0.50 for 28-joint Disease Activity Score remission).Conclusion.The longterm retention of the first TNFi administered to patients with SpA is high, especially for males with axial disease. The strongest predictor of longterm TNFi survival is a major response within the first year of treatment.

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Section: Rheumatologysupporting

confidence: 88%

Comparative Analysis and Predictors of 10-year Tumor Necrosis Factor Inhibitors Drug Survival in Patients with Spondyloarthritis: First-year Response Predicts Longterm Drug Persistence

Flouri

Markatseli²,

Boki³

et al. 2018

J Rheumatol

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“…There is no evidence that combining MTX with TNFi improves efficacy, but it may affect persistence in peripheral SpA. In AS, addition of MTX to IFX did not affect outcomes, infusion numbers, TNFi switching, or dosing 111,112,113,114,115 . In PsA, RCT demonstrated clinical and radiographic efficacy of several TNFi regardless of concomitant MTX 102,106,116,117,118 .…”

Section: Tumor Necrosis Factor Inhibitors (Tnfi)mentioning

confidence: 90%

2014 Update of the Canadian Rheumatology Association/Spondyloarthritis Research Consortium of Canada Treatment Recommendations for the Management of Spondyloarthritis. Part II: Specific Management Recommendations

Rohekar

Chan²,

Tse³

et al. 2015

J Rheumatol

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“…However, three clinical trials comparing infliximab alone to a combination of infliximab and methotrexate found no superiority in terms of efficacy and allergic adverse events for the combination therapy. [34][35][36] Thus, no evidence current ly supports the use of such a regimen.…”

Section: Immunogenicity Efficacy and Switchingmentioning

confidence: 96%

Developments in therapies for spondyloarthritis

Sieper

2012

Nat Rev Rheumatol

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First-line therapy for spondyloarthritis (SpA) has not yet altered in the wake of new classification criteria; NSAIDs and physical therapy are recommended. Anti-TNF agents can be used when NSAIDs fail, but their efficacy has potentially been limited in previous trials by inclusion criteria requiring the presence of established, active disease. Now, not only patients with axial SpA (axSpA) with radiographic signs of sacroiliitis (that is, with ankylosing spondylitis), but also patients in whom structural damage is not-yet-visible radiographically (non-radiographic axSpA) can be included in trials of therapy for axSpA. TNF blockers, it seems already, are at least similarly effective in patients with non-radiographic axSpA as in those with established AS. Short symptom duration and a positive C-reactive protein test at baseline are currently the best predictors for a good response to TNF-blocking agents. Biologic agents besides anti-TNF therapies have so far failed in the treatment of axSpA. New bone formation seems currently to be best prevented by NSAIDs, not by TNF blockers. Whether earlier effective treatment of bony inflammation with anti-TNF therapy will be able to prevent ossification at a later stage has yet to be determined. New classification criteria for peripheral SpA will also allow treatment trials to be conducted more systematically than has previously been possible in this subgroup of patients.

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Infliximab in ankylosing spondylitis: alone or in combination with methotrexate? A pharmacokinetic comparative study

Cited by 39 publications

References 19 publications

Comparative Analysis and Predictors of 10-year Tumor Necrosis Factor Inhibitors Drug Survival in Patients with Spondyloarthritis: First-year Response Predicts Longterm Drug Persistence

Comparative Analysis and Predictors of 10-year Tumor Necrosis Factor Inhibitors Drug Survival in Patients with Spondyloarthritis: First-year Response Predicts Longterm Drug Persistence

2014 Update of the Canadian Rheumatology Association/Spondyloarthritis Research Consortium of Canada Treatment Recommendations for the Management of Spondyloarthritis. Part II: Specific Management Recommendations

Developments in therapies for spondyloarthritis

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