A 3 mg/kg starting dose of infliximab in active spondyloarthritis resistant to conventional treatments is efficient, safe and lowers costs.
OBJECTIVE
We assessed the efficacy, tolerance and cost of a 3 mg/kg starting dose of infliximab for ankylosing spondylitis (AS) and psoriatic arthritis (PsA).


METHODS
We retrospectively followed-up 45 biologic-naive consecutive patients (11 with axial AS, 24 with axial and peripheral [mixed] AS and 10 with PsA) who were treated between 2002 and 2005 with a 3 mg/kg dose of infliximab after failure of conventional therapies. The following variables were recorded: visual analog scale (VAS) scores of patient's global (G) and pain (P) assessment, duration of early morning stiffness (EMS), disease activity (BASDAI) and functional disability (BASFI). Treatment responses were assessed at 6 and 12 months using the AS assessment score (ASAS)-20% and -40% criteria and BASDAI-50.


RESULTS
Baseline characteristics of the 29 men and 16 women were (median [range]): G-VAS, 70 [13-100]; P-VAS, 70 [13-100]; EMS, 60 [0-180] minutes; BASDAI, 64.4 [23.9-100]; BASFI, 57.2 [3.5-98.5]. All manifestations regressed significantly (p<0.0001) for 39 (86.7%) and 24 (53.5%) patients at 6 and 12 months, respectively; 26 (57.8%) had achieved ASAS-20 responses at 6 months that persisted at 1 year for 20 (44.4%); 19 (42.2%) and 12 (26.7%) satisfied BASDAI 50 criteria at 6 and 12 months, respectively. Interestingly, almost 30% still received low-dose infliximab after 4 years of follow-up.


CONCLUSIONS
An initial dose of 3 mg/kg of infliximab significantly attenuated AS and PsA manifestations in>40% of the patients, making use of this dose highly advantageous in terms of safety and 33% lower cost.
Tenga
Ginette
G
Department of Pharmacy, Rouen University Hospital, 76031 Rouen cedex, France.
Goëb
Vincent
V
Lequerré
Thierry
T
Bacquet-Deschryver
Hélène
H
Daragon
Alain
A
Pouplin
Sophie
S
Lanfant-Weybel
Karine
K
Le Loët
Xavier
X
Dieu
Bernard
B
Vittecoq
Olivier
O
D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage* / Q000191:economics; D018501:Antirheumatic Agents / Q000008:administration & dosage* / Q000191:economics; D015535:Arthritis, Psoriatic / Q000188:drug therapy / Q000191:economics; D017046:Cost Savings; D004305:Dose-Response Relationship, Drug; D016527:Drug Costs; D004351:Drug Resistance; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013167:Spondylitis, Ankylosing / Q000188:drug therapy* / Q000191:economics*; D016896:Treatment Outcome; D055815:Young Adult
D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D000069285:Infliximab