Use of Anti-TNF α Agents (Infliximab and Etanercept) in Rheumatoid Arthritis and Ankylosing Spondylitis: Experience of a Rheumatology Practice at Apollo Hospitals, India

Abstract

Study design A retrospective analysis of the use of Biological Response Modifiers (BRMs) infliximab and etanercept in patients with inflammatory spine (ankylosing spondylitis-AS) and inflammatory joint conditions (rheumatoid arthritis-RA) – experience of the author at Apollo Hospitals, Hyderabad and Indraprastha Apollo Hospitals, New Delhi over the past 5 years. Methods The patients were evaluated with special reference to the ACR (American College of Rheumatology) 20, 50, and 70 responses, the DAS (Disease Activity Score) 28 responses, and the BASDAI (Baath Ankylosing Spondylitis Disease Activity Index). Biochemical parameters and side effect/toxicity profile of these agents was reviewed where data was available. Results Each of the three patients (between years 2000–2003) with RA who were administered infliximab, achieved ACR 20, 50 and 70 responses respectively, depending on the duration of therapy. The three RA patients treated with infliximab (years 2004–2005) achieved significant improvement and two of these had DAS 28 scores less than 4. The three patients with RA (2004–2005) treated with etanercept had equally good responses and one patient discontinued after near complete remission. All three patients with AS (2004–2005) treated with infliximab achieved significant reductions in the disease activity index (BASDAI); one patient with AS and a second with psoritic arthritis, both of whom were treated with etanercept did moderately well. No major side effects or toxicities were reported (except mild allergic reactions in two patients). Discussion Anti TNF α agents were found to be safe and effective in treatment of refractory RA and AS and these are significant additions to the existing armamentarium of medications for this indication.