Assessment of the efficacy of pulse Ibandronate therapy in non-steroidal anti-inflammatory drug refractory ankylosing spondylitis: An open prospective study

Abstract

Background Amino-bisphosphonates like Pamidronate, having weak anti-Tumour Necrosis factor (TNF)-alpha property is effective in ankylosing spondylitis (AS). Objective To assess the efficacy of intravenous pulse Ibandronate, another bisphosphonate, in non-steroidal anti-inflammatory drug (NSAID) refractory/intolerant AS, as it is cheaper, requires less frequent dosing and is easily available. Methods Thirty-four patients, diagnosed as AS by Modified New York Criteria, having Bath AS Disease Activity Index (BASDAI) ≥ 4 (i.e. active disease) and NSAID refractory/intolerant, received six doses of injection Ibandronate (3 mg) intravenously, three monthly, for 15 months. Patients with peripheral arthritis were given sulfasalazine along with Ibandronate. Outcome assessed comparing baseline and final BASDAI, Bath AS metrology index (BASMI), Bath AS functional index (BASFI), Bath AS global score (BAS-G), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Response defined according to assessments in ankylosing spondylitis (ASAS)-20 and BASDAI-50, and, reduction in tender and swollen joint counts in patients with peripheral arthritis. Results Twenty-eight patients received all six doses. Twenty-one (75%) and 23 (82%) patients achieved BASDAI-50 and ASAS-20 responses, respectively. Significant reductions in mean BASDAI (48.36%), BASMI (55.08%), BASFI (47.03%), BASG (47.47%), ESR (49.24%) and CRP (66.38%) were noted after 15 months. Ten patients having peripheral joint involvement had significant decrement in swollen (67.74%) and tender (57.14%) joint counts. Conclusion Intravenous Ibandronate has reasonable efficacy in the treatment of AS.