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Ankylosing spondylitis patients who are responding well to treatment with etanercept can, in some cases, potentially taper their dose without disrupting the effectiveness of the therapy.
This is according to a Pfizer-sponsored study that took place at the Norfolk and Norwich University Hospital, which aimed to investigate whether a 25 mg once-weekly dose of etanercept is effective at maintaining a clinical response in patients with ankylosing spondylitis who have responded to the standard 50 mg dose.
Adult patients who were not responding to conventional therapies were prescribed etanercept 50 mg once weekly for six months, with those performing well randomly assigned to taper to 25 mg once weekly, or continue on the 50 mg dose.
They were followed for a further six months to see whether response rates, as measured by the Bath Ankylosing Spondylitis Disease Activity Index, were affected by the change of dosage.
According to results published in the Journal of Rheumatology, a total of 59 patients were enrolled, with 47 achieving a sufficient clinical response to be eligible for randomisation. Of these, 24 were assigned to continue their current dose, while 23 tapered it downwards.
After six months, 83 per cent of those in the 50 mg arm maintained their clinical response, compared to 52 per cent of the 25 mg arm. This indicates that tapering is suitable for some patients, but not all of them.
The researchers concluded: "Although this pilot study demonstrates that treatment with etanercept 25 mg was less effective at maintaining treatment response in the stepdown phase, 52 per cent of participants maintained treatment response. Future research should address which patients are suitable for tapering."
A spokeswoman for Arthritis Research UK added: "It makes sense to establish whether once ankylosing spondylitis is brought under control by a higher dose of medication, it can be then reduced to a lower maintenance dose, as this is better for the patient and more cost-effective.
"Our researchers are currently investigating the viability of dose-tapering anti-TNF therapy in rheumatoid arthritis, specifically whether it is possible to taper the dose by one-third and two-thirds in patients who had a good response to the drug. Some patients may experience a flare-up as a result, but even if dose-tapering only works in some patients we need to find out."
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Arthritis Fibromyalgia Gout Lupus Rheumatic Rheumatology is the medical specialty concerned with the diagnosis and management of disease involving joints, tendons, muscles, ligaments and associated structures (Oxford Medical Diction...