TNFα blockers followed by continuation of sulfasalazine and methotrexate combination: A retrospective study on cost saving options of treatment in Spondyloarthritis

Clinical Rheumatology | September 13, 2017

Nair AM, et al. - This study was meant to determine the outcome and expenditure incurred in spondyloarthritis (SpA) patients beyond a year of follow-up after receiving 4 doses of infliximab (IFX) over and above background therapy of methotrexate (MTX) and sulfasalazine (SSZ) combination. Investigations suggested that short course IFX dosing followed by the continuation of MTX and SSZ combination could prolong time to disease flare and decrease the demand for additional IFX dose in SpA. Thus, this regimen could be a cost saving option for patients with SpA.


  • In this study, electronic medical records were reviewed for patients with SpA satisfying the Assessment of Spondyloarthritis International Society (ASAS) criteria between 2008 and 2014.
  • Patients who completed at least 1 year of follow-up after receiving four doses of IFX (5 mg/kg at 0, 2, 6, and 14 weeks) on a background therapy of MTX (10–25 mg/week) and SSZ (2–3 g/day) combination were enrolled after obtaining an informed consent.
  • Time to disease flare was considered as the primary outcome. 
  • Changes in acute phase reactants, patient reported outcomes (BASDAI, BASFI), and cost were also evaluated. 


  • This study included 45 patients. 
  • 28.9 (18.7) months was the mean (SD) duration of follow up after fourth IFX dose.
  • Disease flare occurred in 33.3% (15/45) after a mean (SD) duration of 14.5 (10.8) months as compared to 4–6 months described in literature on discontinuing TNFi.
  • At follow-up, reduction in ESR, CRP, BASDAI and BASFI continued to be statistically significant as compared to baseline.
  • As compared to continuous IFX therapy, this treatment reduced cost by 57.1% for each patient-month of follow-up. 

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