title: Long-term drug survival and clinical effectiveness of etanercept treatment in patients with ankylosing spondylitis in daily clinical practice.
abstract: OBJECTIVE
  Randomised controlled trials and open-label extension studies have demonstrated the clinical efficacy and safety of tumour necrosis factor-alpha (TNF-α) blocking therapy in pre-selected study patients with ankylosing spondylitis (AS). Our aim was to investigate the 7-year drug survival and clinical effectiveness of etanercept treatment in AS patients in daily clinical practice.
  
  
  METHODS
  Consecutive AS patients from the prospective observational GLAS cohort who started etanercept because of active disease were included and evaluated over 7 years according to a fixed protocol. Continuation of treatment was based on BASDAI improvement and/or expert opinion.
  
  
  RESULTS
  Of the 89 included AS patients, 45 (51%) were still using etanercept at 7 years of follow-up. Reasons for treatment discontinuation were adverse events (n=22), inefficacy (n=13), or other reasons although good clinical response (n=9). Etanercept treatment resulted in a rapid (after 6 weeks) and sustained improvement in disease activity (BASDAI, ASDAS, CRP, physician GDA), spinal mobility, physical function (BASFI), quality of life (ASQoL), and extra-spinal manifestations (swollen joints, tender joints and tender entheses). Furthermore, concomitant NSAID or DMARD use decreased significantly during follow-up. At 7 years, low disease activity and remission were present in 67-73% and 29-30% of the 45 patients, respectively. Of the patients who discontinued etanercept, 18 switched successfully to a second or third TNF-α blocker during follow-up.
  
  
  CONCLUSIONS
  In a large cohort of AS patients treated with etanercept, approximately 50% continued this treatment for 7 years. Our broad evaluation of clinical endpoints proves the long-term effectiveness of etanercept treatment in daily clinical practice.
authors.affiliation: Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; and Rheumatology, Medical Center Leeuwarden, The Netherlands. s.arends@umcg.nl.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Arends
authors.affiliation: Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, The Netherlands.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Brouwer
authors.affiliation: Rheumatology, Medical Center Leeuwarden, The Netherlands.
authors.forename: Monique
authors.initials: M
authors.lastname: Efde
authors.affiliation: Laboratory Medicine, University of Groningen, University Medical Center Groningen, The Netherlands.
authors.forename: Eveline
authors.initials: E
authors.lastname: van der Veer
authors.affiliation: Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, The Netherlands.
authors.forename: Hendrika
authors.initials: H
authors.lastname: Bootsma
authors.affiliation: Rheumatology, Medical Center Leeuwarden, The Netherlands.
authors.forename: Freke
authors.initials: F
authors.lastname: Wink
authors.affiliation: Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; and Rheumatology, Medical Center Leeuwarden, The Netherlands.
authors.forename: Anneke
authors.initials: A
authors.lastname: Spoorenberg
mesh_terms: D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D000068800:Etanercept / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D012074:Remission Induction; D012720:Severity of Illness Index; D013167:Spondylitis, Ankylosing / Q000175:diagnosis / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D018501:Antirheumatic Agents; D000068800:Etanercept