Treatment of ankylosing spondylitis with TNF blockers: a meta-analysis

Abstract

Biological agents directed against tumor necrosis factor (TNF) represent therapeutic options for patients with ankylosing spondylitis with high disease activity despite use of non-steroidal anti-inflammatory drugs. To evaluate the efficacy and safety of the anti-TNF agents infliximab, etanercept, adalimumab, golimumab, and certolizumab for the treatment of ankylosing spondylitis, we performed a systematic review of randomized clinical trials on adult patients with ankylosing spondylitis using articles culled from the EMBASE, MEDLINE, Cochrane Controlled Trials Register and LILACS databases (September/2012), manual literature search, and the gray literature. Study selections and data collection were performed by two independent reviewers, with disagreements solved by a third reviewer. The following outcomes were evaluated: ASAS 20 response, disease activity, physical function, vertebral mobility, adverse events, and withdraws. The meta-analysis was performed using the Review Manager(®) 5.1 software by applying the random effects model. Eighteen studies were included in this review. No study of certolizumab was included. Patients treated with anti-TNF agents were more likely to display an ASAS 20 response after 12/14 weeks (RR 2.21; 95 % CI 1.91; 2.56) and 24 weeks (RR 2.68; 95 % CI 2.06; 3.48) compared with controls, which was also true for several other efficacy outcomes. Meta-analysis of safety outcomes and withdraws did not indicate statistically significant differences between treatment and control groups after 12 or 30 weeks. Adalimumab, infliximab, etanercept, and golimumab can effectively reduce the signs and symptoms of the axial component of ankylosing spondylitis. Safety outcomes deserve further study, especially with respect to long-term follow-ups.

Autoimuniniu artritu sergančių biologine terapija gydomų pacientų stebėjimo duomenys (lietuvos reumatinių ligų biologinės terapijos duomenų bazės duomenys)

“…The most frequently (617.17/1000 py) AE were observed in RA patients (57.8 % of all AE). Infections were the most frequent AE and this data consist with the literature [37][38][39]. 68.3 % AE were mild or medium, in the most cases (63.9%) patients recovered completely.…”

Cytokines as Therapeutic Targets in Rheumatoid Arthritis and Other Inflammatory Diseases

“…A recent study indirectly comparing the results of different RCTs of anti-TNF therapy for AS in a single evidence synthesis framework confirmed that 292 infliximab 3 mg/kg was not efficacious, whereas there were no significant between-treatment differences for etanercept, adalimumab, infliximab 5 mg/kg, and golimumab (Shu et al, 2013). This was confirmed in a meta-analysis of AS treatment with TNF inhibitors that reported that etanercept, infliximab (5 mg/kg), adalimumab, and golimumab were all effective at reducing the signs and symptoms of the axial (spinal) component of AS, although long-term safety outcomes were still awaited (Machado et al, 2013). A report for the UK National Institute for Health and Care Excellence appraisal of golimumab for AS found there was overlap in the 95% credible intervals between golimumab, etanercept, and adalimumab, apart from a greater risk of treatment discontinuation for golimumab than for etanercept (relative risk, 4.30; 95% CI, 1.01-18.50) (Armstrong et al, 2013).…”

Real-life experience with switching TNF-α inhibitors in ankylosing spondylitis

“…According to the meta-analysis of randomized-controlled trials (RCTs), it became evident that all available TNFi-s (adalimumab, etanercept, infliximab and golimumab) exert similar effects on signs and symptoms of the axial components of the disease (1)(2)(3)(4)(5).…”