title: Predictors of Clinical Remission under Anti-tumor Necrosis Factor Treatment in Patients with Ankylosing Spondylitis: Pooled Analysis from Large Randomized Clinical Trials.
abstract: OBJECTIVE
  Investigate the role and relation of disease duration of different factors for achieving clinical remission with anti-tumor necrosis factor (TNF) treatment in patients with active ankylosing spondylitis (AS).
  
  
  METHODS
  Data pooled from 4 large (n = 1281) clinical trials were used to compare disease duration subgroups for placebo or sulfasalazine (SSZ) versus etanercept (ETN), which, in turn, were analyzed by age of diagnosis ≤ 40 versus > 40 years, HLA-B27 status, and baseline C-reactive protein (CRP) ≤ upper limit of normal (ULN) versus > ULN using chi-square tests, and ANCOVA. The primary efficacy measure was Assessments of SpondyloArthritis international Society (ASAS) partial remission (PR) after 12 weeks of treatment. Also analyzed were Bath AS Disease Activity Index and Functional Index, AS Disease Activity Scores, and ASAS response rates.
  
  
  RESULTS
  Overall, a larger percentage of patients achieved ASAS-PR with ETN versus SSZ or placebo. More patients with ≤ 2-year disease duration treated with ETN experienced partial remission (34%) versus longer disease duration (30%, 27%, and 22% for > 2-5, > 5-10, and > 10 yrs, respectively; all p < 0.05). In the subgroup of patients with both disease duration ≤ 2 years and aged ≤ 40 years at diagnosis, the treatment response was even more pronounced. Similar results were seen in HLA-B27-positive patients in the disease duration ≤ 2-year subgroup. Overall, patients with high CRP at baseline had better treatment responses compared with patients with normal CRP.
  
  
  CONCLUSIONS
  Treatment response under anti-TNF treatment with ETN at 12 weeks was greatest among patients with disease duration ≤ 2 years and even more pronounced in subgroups of patients ≤ 40 years old or HLA-B27-positive at diagnosis.
authors.affiliation: From the Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Bochum, Germany; Department of Specialty Care, Pfizer Inc., Collegeville, Pennsylvania; Inflammation Therapeutic Area, Amgen Inc., Thousand Oaks, California, USA.X. Baraliakos, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum; A.S. Koenig, DO; H. Jones, RN; A. Szumski, MS, Department of Specialty Care, Pfizer Inc.; D. Collier, MD, PhD, Inflammation Therapeutic Area, Amgen Inc.; E. Bananis, PhD, Department of Specialty Care, Pfizer Inc. baraliakos@me.com.
authors.forename: Xenofon
authors.initials: X
authors.lastname: Baraliakos
authors.affiliation: From the Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Bochum, Germany; Department of Specialty Care, Pfizer Inc., Collegeville, Pennsylvania; Inflammation Therapeutic Area, Amgen Inc., Thousand Oaks, California, USA.X. Baraliakos, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum; A.S. Koenig, DO; H. Jones, RN; A. Szumski, MS, Department of Specialty Care, Pfizer Inc.; D. Collier, MD, PhD, Inflammation Therapeutic Area, Amgen Inc.; E. Bananis, PhD, Department of Specialty Care, Pfizer Inc.
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Koenig
authors.affiliation: From the Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Bochum, Germany; Department of Specialty Care, Pfizer Inc., Collegeville, Pennsylvania; Inflammation Therapeutic Area, Amgen Inc., Thousand Oaks, California, USA.X. Baraliakos, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum; A.S. Koenig, DO; H. Jones, RN; A. Szumski, MS, Department of Specialty Care, Pfizer Inc.; D. Collier, MD, PhD, Inflammation Therapeutic Area, Amgen Inc.; E. Bananis, PhD, Department of Specialty Care, Pfizer Inc.
authors.forename: Heather
authors.initials: H
authors.lastname: Jones
authors.affiliation: From the Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Bochum, Germany; Department of Specialty Care, Pfizer Inc., Collegeville, Pennsylvania; Inflammation Therapeutic Area, Amgen Inc., Thousand Oaks, California, USA.X. Baraliakos, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum; A.S. Koenig, DO; H. Jones, RN; A. Szumski, MS, Department of Specialty Care, Pfizer Inc.; D. Collier, MD, PhD, Inflammation Therapeutic Area, Amgen Inc.; E. Bananis, PhD, Department of Specialty Care, Pfizer Inc.
authors.forename: Annette
authors.initials: A
authors.lastname: Szumski
authors.affiliation: From the Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Bochum, Germany; Department of Specialty Care, Pfizer Inc., Collegeville, Pennsylvania; Inflammation Therapeutic Area, Amgen Inc., Thousand Oaks, California, USA.X. Baraliakos, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum; A.S. Koenig, DO; H. Jones, RN; A. Szumski, MS, Department of Specialty Care, Pfizer Inc.; D. Collier, MD, PhD, Inflammation Therapeutic Area, Amgen Inc.; E. Bananis, PhD, Department of Specialty Care, Pfizer Inc.
authors.forename: David
authors.initials: D
authors.lastname: Collier
authors.affiliation: From the Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Bochum, Germany; Department of Specialty Care, Pfizer Inc., Collegeville, Pennsylvania; Inflammation Therapeutic Area, Amgen Inc., Thousand Oaks, California, USA.X. Baraliakos, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum; A.S. Koenig, DO; H. Jones, RN; A. Szumski, MS, Department of Specialty Care, Pfizer Inc.; D. Collier, MD, PhD, Inflammation Therapeutic Area, Amgen Inc.; E. Bananis, PhD, Department of Specialty Care, Pfizer Inc.
authors.forename: Eustratios
authors.initials: E
authors.lastname: Bananis
mesh_terms: D000328:Adult; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D000068800:Etanercept / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D013167:Spondylitis, Ankylosing / Q000188:drug therapy*; D012460:Sulfasalazine / Q000627:therapeutic use*; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha; D012460:Sulfasalazine; D000068800:Etanercept
keywords: ANKYLOSING SPONDYLITIS; EARLY MEDICAL INTERVENTION; ETANERCEPT; PLACEBO; SULFASALAZINE