Anti-TNF therapy of ankylosing spondylitis in clinical practice. Results from the Czech national registry ATTRA.
OBJECTIVE
To estimate efficacy, safety and adherence to therapy of ankylosing spondlitis (AS) patients included in the Czech National Registry ATTRA, and to look for predictive factors for therapy discontinuation.


METHODS
Patients were included according to the guidelines of the Czech Society for Rheumatology, which involve failure of previous therapy, BASDAI >4, and CRP >10 mg/l. Only patients with anti-TNF administered for the first time were analysed. Adherence to therapy was evaluated using Kaplan-Meier analysis and results were presented as cumulative survival. Comparison with data on patients with rheumatoid arthritis (RA) followed in the same registry was made.


RESULTS
310 of AS patients who had reached at least 1 year as well as those who discontinued the treatment before this time point were analysed. Drug survival was longer in patients with AS than in those with RA: 84% vs. 78% and 72% vs. 49% after 1 and 3 years of treatment. Significant risk factors for treatment discontinuation were female gender (RR 2.22, p=0.001) and CRP (RR 1.33, p=0.025). The proportion of patients with BASDAI <4 during the treatment period was higher in the etanercept group than in the infliximab group (p<0.001). The number of patients fully employed increased in the whole group from 48% to 63% after 1 year of treatment.


CONCLUSIONS
Follow-up of patients with AS in the national registry shows that it is an effective and safe way of treatment with longer adherence to anti-TNF therapy in comparison with RA patients.
Institute of Rheumatology, 1st Faculty of Medicine, Charles University Prague, Czech Republic. pavelka@revma.cz
K
K
Pavelka
S
S
Forejtová
J
J
Stolfa
K
K
Chroust
L
L
Buresová
H
H
Mann
J
J
Vencovský
D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000628:therapy; D017281:Cost of Illness; D018153:Czech Republic; D016527:Drug Costs; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D010349:Patient Compliance; D012042:Registries; D012044:Regression Analysis; D012720:Severity of Illness Index; D013167:Spondylitis, Ankylosing / Q000191:economics / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000627:therapeutic use
D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha