title: Biologics Use in Asian Indian Patients with Ankylosing Spondylitis: A Physician's Perspective.
abstract: BACKGROUND
  Ankylosing Spondylitis (AS) with non-steroidal anti-inflammatory drug (NSAID) therapeutic failure is treated with biologics.
  
  
  OBJECTIVE
  To compare the clinical outcomes of different biologics for Asian Indian patients with AS who have NSAID therapeutic failure.
  
  
  METHODS
  Thirty-five AS patients with NSAID failure were administered Etanercept (n=15) (50mg SQ, weekly) or Infliximab (n=20) (5mg/kg IV every 2(nd) month) based on patient convenience or physician discretion as per 2015 ACR/SAA/SPARTAN recommendations. Baseline demographic details, time to diagnosis, disease duration, presence of low backache, early morning stiffness, peripheral joint and extraarticular involvement, ESR, CRP values and HLA-B27 score were obtained. Baseline values of scores of BASMI-3 and MASES were calculated. To monitor the disease activity, BASDAI and ASDAS-ESR scores were recorded at baseline, and after 6 months and 12 months of therapy initiation.
  
  
  METHODS
  Comparison of means: independent samples t-test; comparison of parameters over time: repeated measures ANOVA.
  
  
  RESULTS
  Both groups were comparable in all parameters at therapy initiation except in the baseline BASMI-3 score which was significantly higher in patients who received Etanercept. Over 12 months of treatment, the reduction in disease activity, as evidenced by reduction in the mean BASDAI and ASDAS-ESR scores was statistically significant for all patients when considered together, as well as when Etanercept and Infliximab were considered separately (p<0.0001 in all cases). However, there was no statistically significant difference in the magnitude of reduction in the mean BASDAI and ASDAS-ESR scores between patients who received Etanercept and those who received infliximab (p=0.696 and 0.618 respectively).
  
  
  CONCLUSIONS
  Etanercept and Infliximab offer statistically similar reduction in disease severity in Asian Indian AS patients with NSAID failure. Further studies with larger sample size are warranted.
authors.affiliation: Rheumatologist, INHS Asvini , Colaba, Mumbai, Maharashtra, India .
authors.forename: Anuj
authors.initials: A
authors.lastname: Singhal
authors.affiliation: Consultant Rheumatologist, UB Area , Bareilley, Uttar Pradesh, India .
authors.forename: Darshan
authors.initials: D
authors.lastname: Bhakuni
authors.affiliation: Rheumatologist, Command Hospital , Alipore, Kolkata, West Bengal, India .
authors.forename: Vishal
authors.initials: V
authors.lastname: Marwaha
authors.affiliation: Head, Department of Medicine, INHS Asvini , Colaba, Mumbai, Maharashtra, India .
authors.forename: Vivek
authors.initials: V
authors.lastname: Hande
authors.affiliation: Resident, Department of Medicine, INHS Asvini , Colaba, Mumbai, Maharashtra, India .
authors.forename: Garvit
authors.initials: G
authors.lastname: Bagga
keywords: Disease activity; Etanercept; Infliximab; Spondyloarthritis