Better short-term clinical response to etanercept in Chinese than Caucasian patients with active ankylosing spondylitis.
Tumor necrosis factor-alpha (TNF-α) inhibitors including etanercept have been demonstrated to be very effective in severe ankylosing spondylitis (AS) in Caucasian patients. However, clinical efficacy of etanercept to treat active AS in Chinese patients has not been reported. In this study, a prospective, open-label trial of etanercept (25 mg BIW), involving 46 AS patients from 16 medical centers of Taiwan, was conducted. Questionnaire was utilized to record demographic data and clinical parameters, including Bath AS Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI), Bath AS Global Index (BASGI), Assessment in Ankylosing Spondylitis (ASAS) 20, 50, and 70, and others, before and at different time intervals after etanercept treatment. Laboratory tests including blood chemistry, hematology, urine analysis, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were done at baseline and at weeks 4, 8, and 12. In this 12-week study, etanercept demonstrated rapid and significant improvement in the ASAS20 response criteria (91.3%), at as early as 2 weeks of therapy (71.3%). Partial remission of AS was achieved in 49.3% of patients after 12 weeks of treatment. Disease activity (BASDAI) and function (BASFI) were also significantly improved after 12 weeks etanercept treatment (p < 0.0001 and p < 0.0001, respectively). In addition, significant increase of chest expansion (2.77 ± 1.69 cm versus 3.56 ± 1.82 cm, p = 0.0004) and lumbar flexion (2.11 ± 2.76 cm versus 2.58 ± 3.42 cm, p = 0.0075) and significant reduction of occiput-to-wall distance (6.59 ± 7.14 cm versus 5.32 ± 6.65 cm, p = 0.0006) were also demonstrated. Both ESR and CRP declined significantly after patients were treated with etanercept. There were no severe adverse effects during the treatment period. Etanercept is generally safe, well tolerated, and effective in Chinese patients with severe AS. Clinical efficacy, including partial remission and BASDAI, is even better in Chinese than in Caucasian patients. Further study is required to assess long-term efficacy and safety in Chinese patients with AS.
Chou
Chung-Tei
CT
Division of Allergy-Immunology-Rheumatology, Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Shih-Pai, Taipei, 11217, Taiwan. ctchou@vghtpe.gov.tw
Tsai
Chang-Youh
CY
Liang
Tung-Hua
TH
Chang
Te-Ming
TM
Lai
Chen-Hung
CH
Wei
Cheng-Chung
CC
Chen
Kun-Hung
KH
Lin
Shih-Chang
SC
Yu
Chia-Li
CL
Liou
Lieh-Bang
LB
Luo
Shue-Fen
SF
Lee
Chyou-Shen
CS
Hsue
Yin-Tzu
YT
Huang
Chung-Ming
CM
Chen
Jiunn-Hong
JH
Lai
Ning-Sheng
NS
Cheng
He-Hsiung
HH
Cheng
Tien-Tsai
TT
Lai
Han-Ming
HM
Tsai
Wen-Chan
WC
Yen
Jeng-Hsien
JH
Lu
Ling-Ying
LY
Chang
Chung-Pei
CP
D000328:Adult; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D044466:Asian People; D000068800:Etanercept; D005260:Female; D006304:Health Status; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use*; D020127:Recovery of Function; D012074:Remission Induction; D012720:Severity of Illness Index; D013167:Spondylitis, Ankylosing / Q000188:drug therapy* / Q000208:ethnology* / Q000503:physiopathology; D016896:Treatment Outcome; D044465:White People; D055815:Young Adult
D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D000068800:Etanercept