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

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) > or = 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.

• Authors: R N Jois, J Leeder, A Gibb, K Gaffney, A Macgregor, M Somerville, D G I Scott
• Journal: Rheumatology (Oxford, England) (Rheumatology (Oxford)) Vol. 45 Issue 12 Pg. 1566-9 (Dec 2006) ISSN: 1462-0324 [Print] England
• PMID: 16705043 (Publication Type: Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antibodies, Monoclonal
• Antirheumatic Agents
• Tumor Necrosis Factor-alpha
• Infliximab

Topics

• Adult
• Antibodies, Monoclonal (administration & dosage, economics)
• Antirheumatic Agents (administration & dosage, economics)
• Costs and Cost Analysis
• Drug Administration Schedule
• Drug Costs (statistics & numerical data)
• Female
• Follow-Up Studies
• Humans
• Infliximab
• Male
• Middle Aged
• Severity of Illness Index
• Spondylitis, Ankylosing (drug therapy, economics)
• Treatment Outcome
• Tumor Necrosis Factor-alpha (antagonists & inhibitors)