Infliximab Boosts Rates of Partial Remission in Early, Active Axial Spondyloarthritis

Infliximab added to naproxen led to higher rates of partial remission among patients with spondyloarthropathies, according to a study in the online Rheumatology. Patients with ankylosing spondylitis who received infliximab in addition to naproxen had double the rate of partial remission than patients who received the nonsteroidal anti-inflammatory drug (NSAID) alone.

The study was a post hoc analysis of the Infliximab as First Line Therapy in Patients with Early Active Spondyloarthritis Trial (INFAST). The double-blind trial randomized 150 biologic-naïve patients with early, active axial spondyloarthritis to either IV infliximab (5 mg/kg) plus oral naproxen (1000 mg/day) or to IV placebo plus oral naproxen (1000 mg/day) over 28 weeks.

Among participants, 94 had been diagnosed with ankylosing spondylitis and 56 with nonradiographic axial spondyloarthritis. None had axial spondyloarthritis that was refractory to NSAIDS.

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At the study’s end, patients who received infliximab had higher rates of partial remission as defined by Assessment of SpondyloArthritis International Society criteria than patients who received placebo, researchers found. Predictors of partial remission included treatment with infliximab, younger age, and HLA-B27 status.

Treatment effects were greatest among patients with ankylosing spondylitis, according to the study. By week 28, some 70.5% of patients with ankylosing spondylitis who had received infliximab had achieved partial remission, compared with 33.3% who had received placebo.

The effect was present but smaller among patients with nonradiographic axial spondyloarthritis: 50% of those who had received infliximab achieved partial remission compared with 37.5% of those who had received placebo, researchers reported.

Other efficacy measures, too, showed greater improvement among all participants who received infliximab, including the Bath Ankylosing Spondylitis Disease Activity Index, the Ankylosing Spondylitis Disease Activity Score, the Bath Ankylosing Spondylitis Functional Index, and the EuroQoL 5-dimensions questionnaire, MedPage Today reported.

On the whole, the positive response to NSAIDS as early treatment for patients with ankylosing spondylitis and nonradiographic axial spondyloarthritis can likely be generalized, MedPage Today reported. However, results should not be generalized to patients with axial spondyloarthritis refractory to NSAIDs, according to the article.—Jolynn Tumolo

References:

Sieper J, Rudwaleit M, Lenaerts J, et al. Partial remission in ankylosing spondylitis and non-radiographic axial spondyloarthritis in treatment with infliximab plus naproxen or naproxen alone: associations between partial remission and baseline disease characteristics [published online ahead of print July 13, 2016]. Rheumatology. doi:10.1093/rheumatology/kew230.

Kuznar W. AS responds better than AxSpA to infliximab. MedPage Today. July 25, 2016.