Safety and Clinical Response in Ankylosing Spondylitis after Three Months of Etanercept Therapy

Roshaan Tahir; Nadeem Ashraf; Adnan Manzar; Muhammad Hamza Zaheer; Muhammad Asad Abbas; Ammarah Mehmood

doi:10.51253/pafmj.v74i4.8893

Authors

Roshaan Tahir Department of General Medicine, Pak Emirates Military Hospital/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
Nadeem Ashraf Department of General Medicine, Pak Emirates Military Hospital/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
Adnan Manzar Department of Rheumatology, Combined Military Hospital Lahore/National University of Medical Sciences (NUMS) Pakistan
Muhammad Hamza Zaheer Department of General Medicine, Pak Emirates Military Hospital/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
Muhammad Asad Abbas Department of General Medicine, Pak Emirates Military Hospital/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
Ammarah Mehmood Department of Pathology Armed Forces Institute of Pathology/National University of Medical Sciences (NUMS) Rawalpindi Pakistan

DOI:

https://doi.org/10.51253/pafmj.v74i4.8893

Keywords:

Ankylosing spondylitis; effectiveness; etanercept; safety

Abstract

Objective: To look for safety and clinical response in ankylosing spondylitis after three months of Etanercept therapy and factors associated with response.

Study Design: Prospective longitudinal study.

Place and Duration of Study: Department of Rheumatology and Medicine, Pak Emirates Military Hospital Rawalpindi Pakistan, from Apr 2021 to Jun 2022.

Methodology: Patients with ankylosing spondylitis diagnosed based on Modified New York criteria in the rheumatology department of our hospital were recruited. Bath Ankylosing Spondylitis Disease Activity Index was calculated for all the patients included in the study at baseline and 12 weeks after the treatment. Relevant socio-demographic factors were associated with significant clinical improvement using Etanercept in patients included in our analysis.

Results: Out of 102 patients of ankylosing spondylitis treated with a biological agent (Etanercept), 94(92.2%) had adequate clinical response. In contrast, 8(7.8%) patients did not have adequate clinical response on the Bath Ankylosing Spondylitis Disease Activity Index. The mean age of the study participants was 38.61±7.88 years. The presence of comorbid illnesses and raised levels of erythrocyte sedimentation rate were significantly associated with poor response to treatment with Etanercept in our study participants (p-value<0.05).

Conclusion: More than 90% of the patients had adequate clinical response at the end of three months of treatment with Etanercept. Patients with comorbid medical conditions or raised ESR levels were more at risk of inadequate treatment response with this newer biological agent than other patients.

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References

Wu A, March L, Zheng X, Huang J, Wang X, Zhao J, et al. Global low back pain prevalence and years lived with disability from 1990 to 2017: estimates from the Global Burden of Disease Study 2017. Ann Transl Med 2020; 8(6): 299.

https://doi.org/10.21037/atm.2020.02.175

Wu A, Dong W, Liu S, Cheung JPY, Kwan KYH. The prevalence and years lived with disability caused by low back pain in China, 1990 to 2016: findings from the global burden of disease study 2016. Pain. 2019; 160(1): 237-245.

https://doi.org/10.1097/j.pain.0000000000001396

Maguire S, Fitzgerald G, Gallagher P, O'Shea F. Advances in treatment of axial spondyloarthritis are associated with improved patient outcomes: data from the Ankylosing Spondylitis Registry of Ireland (ASRI). Rheumatol Int 2022; 42(5): 831-838. https://doi.org/10.1007/s00296-021-05067-z

Louis-Sidney F, Kahn V, Suzon B, Bandt MD, Deligny C, Arfi S, et al. Epidemiology and Characteristics of Spondyloarthritis in the Predominantly Afro-Descendant Population of Martinique, a French Caribbean Island. J Clin Med 2022; 11(5): 1299.

https://doi.org/10.3390/jcm11051299

Zhu W, He X, Cheng K, Zhang L, Chen D, Wang X et al. Ankylosing spondylitis: etiology, pathogenesis, and treatments. Bone Res 2019; 7(3): 22.

https://doi.org/10.1038/s41413-019-0057-8

Lindström U, Olofsson T, Wedrén S, Qirjazo I, Askling J. Biological treatment of ankylosing spondylitis: a nationwide study of treatment trajectories on a patient level in clinical practice. Arthritis Res Ther 2019; 21(1): 128.

https://doi.org/10.1186/s13075-019-1908-9

Zhao D, He D, Bi L, Wu H, Liu Y, Wu Z et al. Safety and Efficacy of Prefilled Liquid Etanercept-Biosimilar Yisaipu for Active Ankylosing Spondylitis: A Multi-Center Phase III Trial. Rheumatol Ther 2021; 8(1): 361-374.

https://doi.org/10.1007/s40744-021-00276-1

Dong Y, Li P, Xu T, Bi L. Effective serum level of etanercept biosimilar and effect of antidrug antibodies on drug levels and clinical efficacy in Chinese patients with ankylosing spondylitis. Clin Rheumatol 2019; 38(6): 1587-1594.

https://doi.org/10.1007/s10067-018-04424-x

Huang ZX, Deng WM, Guo X, Huang ZP, Huang YK, Lin CL, et al. Clinical and MRI response to dose reduction of an etanercept-biosimilar for hip arthritis in patients with ankylosing

spondylitis: an observational, retrospective cohort study. Clin Rheumatol 2019; 38(6): 1595-1604.

https://doi.org/10.1007/s10067-019-04466-9

Ahsan T, Erum U, Jabeen R, Khowaja D. Ankylosing Spondylitis: A rheumatology clinic experience. Pak J Med Sci. 2016; 32(2): 365-368. https://doi.org/10.12669/pjms.322.9366

Lord PA, Farragher TM, Lunt M, Watson KD, Symmons DPM, Hyrich KL, et al. Predictors of response to anti-TNF therapy in ankylosing spondylitis: results from the British Society for Rheumatology Biologics Register. Rheumatology 2010; 49(3): 563-570.

https://doi.org/10.1093/rheumatology/kep422

Korotaeva T, Dina O, Holdsworth E, Fallon L, Milligan G, Meakin S, et al. Correction to: Investigating diagnosis, treatment, and burden of disease in patients with ankylosing spondylitis in Central Eastern Europe and the United States: a real‑world study. Clin Rheumatol 2022; 41(4): 1269.

https://doi.org/10.1007/s10067-022-06069-3

Lubrano E, Parsons WJ, Perrotta FM. Assessment of Response to Treatment, Remission, and Minimal Disease Activity in Axial Psoriatic Arthritis Treated with Tumor Necrosis Factor Inhibitors. J Rheumatol 2016; 43(5): 918-923.

https://doi.org/10.3899/jrheum.151404

van der Heijde D, Da Silva JC, Dougados M, Geher P, van der Horst-Bruinsma I, Juanola X, et al. Etanercept 50 mg once weekly is as effective as 25 mg twice weekly in patients with ankylosing spondylitis. Ann Rheum Dis 2006; 65(12): 1572-1577.

https://doi.org/10.1136/ard.2006.056747

Lindström U, Glintborg B, Di Giuseppe D, Nordstrom D, Proven SA, Gudbjornsson B, et al. Treatment retention of infliximab and etanercept originators versus their corresponding biosimilars: Nordic collaborative observational study of 2334 biologics naïve patients with spondyloarthritis. RMD Open 2019; 5(2): e001079. https://doi.org/10.1136/rmdopen-2019-001079

Zhang K, Zheng Y, Han Q, Liu Y, Wang W, Ding J, et al. The Clinical and MRI Effect of TNF-α Inhibitors in Spondyloarthritis Patients With Hip Involvement: A Real-World Observational Clinical Study. Front Immunol 2021; 12: 740980.

https://doi.org/10.3389/fimmu.2021.740980

Huang Y, Chen Y, Liu T, Lin S, Yin G, Xie Q. Impact of tumor necrosis factor α inhibitors on MRI inflammation in axial spondyloarthritis assessed by Spondyloarthritis Research Consortium Canada score: A meta-analysis. PLoS One 2020;15(12): e0244788.

https://doi.org/10.1371/journal.pone.0244788

Yang R, Liu H, Fan M. A quick decrease of bone marrow edema in sacroiliac joint could be served as a novel marker for dose tapering of etanercept in ankylosing spondylitis patients. Medicine 2019; 98(11): e14620.

https://doi.org/10.1097/MD.0000000000014620