Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement
The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.
Infliximab Withdrawal in Patients with Spondyloarthritis Who Presented Criteria of Clinical Disease Remission. An Open Study of Clinical Practise (REMINEA)
Torrente1, V., Gratacos2, J., Juanola3, X., Sanmarti4, R., Suarez5, D., Moreno6, M., REMINEA Group,
Hospital Sant Pau, Barcelona, Spain,
H Parc Taulí, Barcelona, Spain,
Hospital Universitari Bellvitge (IDIBELL), Barcelona, Spain,
H Clínic i Provincial, Barcelona, Spain,
Parc Taulí Hospital, Sabadell, Spain,
Parc Tauli Hospital, Sabadell, Spain
Anti-TNF therapy (infliximab) has demonstrated good efficacy, especially in early-onset spondyloarthritis patients. However, the consequences of infliximab withdrawal in these patients are not yet determined, particularly in those who reach an excellent response.
To evaluate the percentage of patients under infliximab treatment who achieve criteria of clinical remission. To assess, after 1 year follow-up, the outcome after infliximab withdrawal in disease remission achieved patients and in the re-treated ones since they had a disease flare.
107 patients (70%M) mean age 42 yrs (2072) with spondylarthitis (82 with ankylosing spondylitis, 25 with undifferentiated spondylarthritis) who met criteria of anti-TNF therapy were included and treated with infliximab (5mg/Kg, 0,2, 6 and every 8 weeks infusions). The mean disease duration before treatment was 11 yrs (0.539), 50% of patients included had less than 10 yrs of disease evolution. Infliximab withdrawal was performed in those patients who presented persistent clinical remission (two consecutive visits, after the induction period) defined as both absence of peripheral arthritis/enthesitis and presence of a BADAI<=2 and a CRP<=0.8mg/dl. During the discontinuation treatment period (»1yr) patients who presented a flare (BASDAI>=4) were re-treated with infliximab (5mg/Kg every 8 weeks.
36/107 patients (34%) achieved remission criteria. Remission patients compared to non-remission ones were significantly younger (39 vs 43 p=0.05) had a lesser disease evolution (9 vs 14, p=0.04) and more disease activity (CRP 3.4 vs 1.6 mg/dl, p=0.005). Over the treatment discontinuation period 21/36 patients (58%) presented a flare (62% during the first 6 months). After reintroduction of infliximab therapy 11/21 (52%) again reached clinical remission, and only 3/21 (14%) did not achieved a significant response (BASDAI>=4). No other problems associated to re-treatment were observed.
Infliximab as continuous therapy appears to be the best choice in this group of patients with spondylarthritis. However, we observed both high (34%) percentage of complete remission patients during 1yr follow-up, and good efficacy and safety of infliximab re-treatment in reactivated patients. In terms of cost-effectiveness, these findings seem to reinforce the infliximab withdrawal in clinical practise in patients who get persistent clinical remission.
To cite this abstract, please use the following information:
Torrente, V., Gratacos, J., Juanola, X., Sanmarti, R., Suarez, D., Moreno, M., et al; Infliximab Withdrawal in Patients with Spondyloarthritis Who Presented Criteria of Clinical Disease Remission. An Open Study of Clinical Practise (REMINEA) [abstract]. Arthritis Rheum 2009;60 Suppl 10 :1785