Rheumatology Medical News about circulating concentration of infliximab;ankylosing spondylitis

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Circulating concentration of infliximab and response to treatment in ankylosing spondylitis: Results from a randomized control study
Arthritis Care and Research , 05/04/09

Krzysiek R et al. – Responsiveness to infliximab treatment is highly heterogeneous among individuals with ankylosing spondylitis (AS); this parameter overcomes the circulating infliximab concentration to explain treatment success or failure.

Methods

Study compares the circulating infliximab concn and the presence of clinical symptoms in pts continuously treated with infliximab or after treatment interruption
Pts with active AS were randomly assigned at week 0 to receive:
- infliximab either at wks 4, 6, 10, and then every 6 wks (continuous treatment; n=93), or
- at wks 4, 6, and 10 and then upon symptom recurrence (on-demand treatment)
Circulating concn of infliximab was determined:
- early during treatment and at wks 46 and 52 for the continuous treatment group or
- upon relapse for the on-demand group
Response in the continuous treatment group was defined at wk 58 for 20% improvement

Results

In continuous treatment group, treatment failure was not associated with a low circulating concn of infliximab, either during early treatment or at 1 yr
- 39.2% of the 28 nonresponders had an infliximab concn of >10 µg/ml at wk 52
- whereas 9/65 (13.8%) responders had an infliximab concn of <1 µg/ml
In the on-demand group, the infliximab concn at relapse closely correlated with the time to relapse
- however, 24/65 (36.9%) had a resurgence of clinical symptoms at an infliximab concn of >10 µg/ml
- whereas 25 pts (38.4%) had a relapse at an infliximab concn of <0.5 µg/ml

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