title: Patient-tailored dose reduction of TNF-α blocking agents in ankylosing spondylitis patients with stable low disease activity in daily clinical practice.
abstract: OBJECTIVE
  Tumour necrosis factor-alpha (TNF-α) blocking agents are very effective in controlling systemic inflammation and improving clinical assessments in ankylosing spondylitis (AS). In view of potential side effects and high costs of long-term treatment, our aim was to investigate whether dose reduction of TNF-α blocking agents is possible without loss of effectiveness in AS patients in daily clinical practice.
  
  
  METHODS
  Patients from the prospective observational GLAS cohort, fulfilling the modified New York criteria for AS, with active disease before start of TNF-α blocking therapy and stable (≥6 months) low disease activity on the conventional dose regimen, who started with dose reduction of TNF-α blocking therapy before June 2011 were studied. Dose reduction was patient-tailored (step-by-step approach) and consisted of lowering the dose and/or extending the interval between doses.
  
  
  RESULTS
  Between June 2005 and March 2011, 58 AS patients started dose reduction of etanercept (n=39), infliximab (n=10), or adalimumab (n=9). Of all patients, 74%, 62%, and 53% maintained their reduced dose or dosing frequency after 6, 12, and 24 months, respectively. The mean dose of TNF-α blocking therapy over time corresponded to 62% of the standard dose regimen. Disease activity remained low in the majority of patients who maintained dose reduction after 24 months (94% had BASDAI<4). If there was recurrence of disease symptoms, patients achieved good clinical response after returning to the conventional regimen (88% reached BASDAI<4).
  
  
  CONCLUSIONS
  In this observational cohort, patient-tailored dose reduction of TNF-α blocking agents was successful preserving stable low disease activity over 24 months in approximately half of the AS patients.
authors: Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; and Rheumatology, Medical Center Leeuwarden, The Netherlands.
authors: Suzanne
authors: S
authors: Arends
authors: Laboratory Medicine, University of Groningen, University Medical Center Groningen, The Netherlands.
authors: Eveline
authors: E
authors: van der Veer
authors: Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, The Netherlands.
authors: Fleur B S
authors: FB
authors: Kamps
authors: Rheumatology, Medical Center Leeuwarden, The Netherlands.
authors: Pieternella M
authors: PM
authors: Houtman
authors: Rheumatology, Medical Center Leeuwarden, The Netherlands.
authors: Reinhard
authors: R
authors: Bos
authors: Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, The Netherlands.
authors: Hendrika
authors: H
authors: Bootsma
authors: Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, The Netherlands.
authors: Elisabeth
authors: E
authors: Brouwer
authors: Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; and Rheumatology, Medical Center Leeuwarden, The Netherlands.
authors: Anneke
authors: A
authors: Spoorenberg
mesh_terms: D000068879:Adalimumab; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage; D001688:Biological Products / Q000008:administration & dosage*; D002985:Clinical Protocols; D054796:Drug Dosage Calculations; D000068800:Etanercept; D006801:Humans; D007074:Immunoglobulin G / Q000008:administration & dosage; D000069285:Infliximab; D008137:Longitudinal Studies; D009426:Netherlands; D011446:Prospective Studies; D018124:Receptors, Tumor Necrosis Factor / Q000008:administration & dosage; D012074:Remission Induction; D012720:Severity of Illness Index; D013167:Spondylitis, Ankylosing / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D013997:Time Factors; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D001688:Biological Products; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept