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Erythrocyte sedimentation rate, CRP level, and serum amyloid a protein for patient selection and monitoring of anti-tumor necrosis factor treatment in ankylosing spondylitis
Arthritis Care and Research , 11/02/09

de Vries MK et al. – The goal of this study was to study the usefulness of ESR, CRP, and serum amyloid A (SAA) for response prediction and monitoring of anti-tumor necrosis factor (anti-TNF) treatment in ankylosing spondylitis (AS) patients. ESR, CRP, and SAA were significantly associated with the BASDAI over 3 months, and the association with ESR was the strongest. Elevated baseline CRP and SAA levels revealed the highest predictive value for response. Together, this study demonstrates that inflammatory markers, and notably CRP and SAA, may facilitate patient selection and monitoring of efficacy of anti-TNF treatment in AS, and could be added to response criteria.

Methods

Patients included consecutively before starting etanercept or infliximab treatment. ASsessment in Ankylosing Spondylitis (ASAS) response, defined as 50% improvement or absolute improvement of 2 points of Bath Ankylosing Spondylitis Disease Activity Index (BASDAI; 0-10 scale), assessed at 3 months
Inflammatory markers and BASDAI collected at baseline and 1 and 3 months
Longitudinal data analysis performed to compare associations between inflammatory markers and BASDAI over time by calculating standardized betas
Predictive values of baseline levels of inflammatory markers for ASAS response calculated

Results

155 patients included
After 3 months of treatment, 70% in etanercept cohort and 71% in the infliximab cohort responded
All markers, notably SAA, decreased significantly
Standardized betas 0.49 for ESR, 0.43 for CRP, and 0.39 for SAA
Normal baseline levels of CRP and SAA significantly associated with nonresponse
Combination of elevated CRP and SAA levels at baseline revealed highest predictive value (81%) for ASAS response