Low-dose infliximab treatment for ankylosing spondylitis - clinically- and cost-effective

R. N. Jois, L. Leeder, A. Gibb, K. Gaffney, A. J. MacGregor, M. Somerville, D. G. I. Scott

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Abstract

Objectives: Infliximab has been shown to be effective in the treatment of ankylosing spondylitis (AS) when treated in a dose of 5 mg/kg at 6 weekly intervals. This dose of infliximab has not been determined by any structured randomized trials and has significant cost implications. We describe our experience of treating AS with low-dose infliximab (3mg/kg at 8 weekly intervals). The efficacy and cost implications are discussed.

Methods: Patients who had active AS [Bath AS Disease Activity Index (BASDAI)≥ 4] were treated with infliximab 3 mg/kg at 0, 2, 6 weeks and thereafter at 8 weekly intervals. Response to treatment was defined as 50% improvement in BASDAI. Other response criteria such as ASAS 20, 40 and five of the six criteria were also assessed. Direct drug costs for infliximab were determined.

Results: Twenty-two consecutive AS patients received infliximab. All 22 completed treatment for 3 months, 15 patients for 6 months and 14 for 12 months. Mean age was 45 years (range 21–62) and mean disease duration 14.5 years (range 2–43). Of the patients, 54% achieved a 50% BASDAI response at 3 months and the benefit was sustained at 12 months in 63%. Similar response rate was seen with the other assessment criteria. Direct drug costs were significantly lower when low-dose infliximab regimen was used.

Conclusions: Low-dose infliximab (3 mg/kg at 8 weekly infusions) is effective in the treatment of AS. Higher doses are required in a small proportion of patients when treatment is only partially effective. Titrating the dose and frequency of infusions may be required in individual patients to achieve optimal response. Using low-dose infliximab has significant economic implications.
Original languageEnglish
Pages (from-to)1566-1569
Number of pages4
JournalRheumatology
Volume45
Issue number12
DOIs
Publication statusPublished - 2006

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