Frequency and duration of drug-free remission after 1 year of treatment with etanercept versus sulfasalazine in early axial spondyloarthritis: 2 year data of the ESTHER trial

Annals of Rheumatic Diseases, 04/13/2012

Song IH et al. – Patients with axial spondyloarthritis treated with etanercept (ETA) over 1 year did not reach drug–free remission in a higher percentage compared to patients from a control group treated with sulfasalazine (SSZ).


  • At week 48, patients who reached study remission (Assessment of Spondyloarthritis international Society (ASAS) plus MRI remission) were followed up without active treatment up to 1 year.
  • In case of a flare, patients were treated with ETA for another year.
  • All patients who were not in ASAS plus MRI remission at week 48 were treated with ETA in year 2.


  • ASAS plus MRI remission at week 48 was reached significantly more often in ETA–treated compared to SSZ–treated patients (33% vs 11%, p=0.03).
  • However, the flare rate was not different between these two groups: 69% in the ETA group versus 75% in the SSZ group.
  • Only 8% of patients initially treated with ETA versus 3% of those initially treated with SSZ reached permanent drug–free remission (not significant).
  • After treatment with ETA over 1 year, patients with flare showed an improvement in all clinical and imaging variables.

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