This article is more than 5 years old. Information may no longer be current.
Infliximab at higher dosage most effectively treated ankylosing spondylitis patients
Infliximab therapy of 5 mg/kg at 0, 2 and 6 weeks was the most effective treatment for patients with ankylosing spondylitis in a comparison of anti-tumor necrosis factor-alpha treatments, according to study results.
Researchers in China conducted a literature search for randomized controlled trials (RCTs) that assessed the efficacy of anti-tumor necrosis factor-alpha (anti-TNF-a) agents, including adalimumab, etanercept, infliximab and golimumab, for treating patients with ankylosing spondylitis. Direct and indirect comparisons were conducted randomly using a Bayesian analysis. The proportion of patients achieving Assessment in Ankylosing Spondylitis Response Criteria (ASAS 20) at 12 weeks of follow-up was the main outcome. Analysis was based on intention-to-treat.
Fourteen RCTs including 17,833 patients were included. Eight trials included etanercept; four; infliximab; one, golimumab; one, adalimumab. There were seven treatment strategies, including placebo. In clinical index ASAS 20, all treatments except 3 mg/kg infliximab at 0, 2 and 6 weeks were more effective than placebo.
Using 25 mg etanercept twice a week as reference, researchers said 50 mg etanercept once a week (OR=1.22), 50 mg golimumab (OR=1.25), 100 mg golimumab every four weeks (OR=1.29), 5 mg/kg infliximab at 0, 2, 6 weeks (OR=1.38) and 40 mg adalimumab every other week for 12 weeks (OR=1.25) seemed to be more effective. They also said 50 mg etanercept twice weekly showed similar efficacy (OR=1.06), while infliximab 3 mg/kg at 0, 2, 6 weeks was less effective (OR=0.69).
No significant analysis was detected in the between-treatment comparisons.
“Ranking analysis suggested that infliximab at 5 mg/kg at 0, 2 and 6 weeks may be the most efficacious therapy,” the investigators concluded. “Future studies could pay more attention to the comparison of different anti-TNF agents, instead of comparison between anti-TNF agents and placebo.”
Disclosure: The researchers report no relevant financial disclosures.