ANTI-INFLAMMATORY DRUGS SPARRING AS A REFLECT OF INFLIXIMAB THERAPY EFFICACY IN REFRACTORY SPONDYLOARTHROPATHIES

Background: For the past decades, nonsteroidal anti-inflammatory drugs (NSAID) have been the mainstay of management of spondyloarthropathies (SpA). However, they may be associated with renal and gastrointestinal toxicity. Several successful clinical trials with infliximab in patients with Crohn disease and rheumatoid arthritis have been reported. Data on its use in SpA have become available only over the last 3 years and supports spectacular efficacy.Objectives: To evaluate efficacy of infliximab in refractory SpA in daily practice and its consequence on anti-inflammatory drugs consummation.Methods: Selection of patients with SpA (according to ESSG criteria) refractory to NSAIDs. Infliximab infusions (3 mg/Kg) on weeks (W) 0, 2, 6, 14, 22 and 30 in combination with Methotrexate. The therapeutic response was evaluated before each infusion on clinical parameters including VAS for pain, number of tender and swollen joints, BASDAI, BASFI, on biological items: ESR and CRP levels and on NSAID and corticosteroïd consummation.Results: 26 patients were included in the study, 23 males and 3 females (mean age 46,7 years). Mean disease duration was 17,9 years. 5 patients were suffering from psoriatic arthritis (PsA) and 21 from ankilosing spondylitis (AS). 7 patients had only axial involvement, 6 had peripheral involvement and 13 had mixed axial and peripheral SpA. 5 patients had inflammatory bowel disease. 20 patients were HLA-B27 positive. A mean of 2,5 DMARD were previously given to these patients. 20 patients were receiving NSAID, and 6 patients were given corticosteroids.All clinical (pain scale, BASFI, BASDAI) and biological (ESR, CRP level) parameters dramatically improved during the first infusions, and the mean differences to the baseline were highly significant until week 14. In the same time, the consummation of NSAID decreased significantly (mean sparring 27% at W14, 33% at W22). Then after, some parameters, evaluated at the day of the infusion, were not so good and did not differ significantly from baseline. This seemed to reflect the insufficiency of the infliximab dosage or the too long interval (8 weeks) between two infusion, responsible for reappearance of symptoms during the few days or weeks before the following infusion. However, the consummation of NSAIDs remained stable, reflect of the global efficacy of infliximab therapy. W0 W2 W6 W14 W22 W30 VAS for pain 64,8 42,17 22,4 17,4 19,25 21,83 BASFI 59,1 45,6 33 24 26,4 27,2 BASDAI 57,2 41,3 25,4 24,1 20,5 30,1 ESR 44,6 15,5 9,9 8,4 19,4 12,1 CRP 37,5 6,5 6,6 5,9 21,8 14,6 NSAID consummation 100% -23% -27% -33% -40% -43% ]Conclusion: Infliximab is efficient in SpA and efficacy appears shortly after the first infusion. So patients can reduce their NSAID consummation, which is very interesting when they have inflammatory bowel disease or renal insufficiency. However, the 8 weeks interval between two infusions seems too long, at least in some patients, and this results in raising of disease activity parameters just before the new infusion, altering the classical assessment criteria. In that case, mean NSAID consummation could better reflect the average efficacy of infliximab therapy.Citation: , volume , supplement , year 2003, page Session: Spondylarthropathies including psoriatic arthritis