Clinical Rheumatology

, Volume 29, Issue 10, pp 1149–1154 | Cite as

Extended dosing of etanercept 25 mg can be effective in patients with ankylosing spondylitis: a retrospective analysis

  • Jaejoon Lee
  • Jung-Won Noh
  • Ji Won Hwang
  • Ji-Min Oh
  • Hyungjin Kim
  • Joong Kyong Ahn
  • You Sun Lee
  • Hoon-Suk Cha
  • Eun-Mi KohEmail author
Original Article


As a measure of healthcare cost containment, the total number of vials of entanercept (25 mg) that can be prescribed for patients with inflammatory arthritis is restricted in Korea. Consequently, attempts to extend the dosing interval while maintaining the efficacy have not been an uncommon clinical practice. The aim of this study was to determine if extended doing interval of etanercept can be effective in patients with ankylosing spondylitis (AS). We performed a retrospective analysis using medical records at a single tertiary hospital. One hundred and nine patients with AS and 79 patients with rheumatoid arthritis (RA) started on etanercept between November 2004 and November 2009 were indentified. Etanercept (25 mg) was started with twice-weekly dosing schedule. Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), C-reactive protein (CRP), and etanercept dosing interval for AS patients at 0, 3, 9, 15, 21 months were reviewed. Dosing interval for RA patients was analyzed for comparison. In AS, mean dosing interval was 4.7 ± 2.1 days at 3 months and was increased to 12.1 ± 7.0 days at 21 months. Despite the progressive increase in the dosing interval, the mean BASDAI declined rapidly at 3 months, and continued to decrease over 21 months. Mean CRP declined after 3 months of therapy and remained low thereafter. In RA, mean dosing interval was 4.0 ± 1.2 days at 3 months and 5.1 ± 1.8 days at 21 months. In conclusion, in AS, extended dosing of etanercept can be effective without compromising clinical and laboratory markers of disease activity as measured by BASDAI and CRP, respectively. Tapering of etanercept was less accommodating in RA when compared to AS.


Ankylosing spondylitis BASDAI Efficacy Etanercept Rheumatoid arthritis TNF antagonist 



Jaejoon Lee, MD and Jungwon Noh, MD equally contributed to this work.




  1. 1.
    Braun J, Bollow M, Remlinger G, Eggens U, Rudwaleit M, Distler A, Sieper J (1998) Prevalence of spondylarthropathies in HLA-B27 positive and negative blood donors. Arthritis Rheum 41:58–67CrossRefPubMedGoogle Scholar
  2. 2.
    Gran JT, Husby G, Hordvik M (1985) Prevalence of ankylosing spondylitis in males and females in a young middle-aged population of Tromso, northern Norway. Ann Rheum Dis 44:359–367CrossRefPubMedGoogle Scholar
  3. 3.
    Clegg DO, Reda DJ, Abdellatif M (1999) Comparison of sulfasalazine and placebo for the treatment of axial and peripheral articular manifestations of the seronegative spondylarthropathies: a Department of Veterans Affairs cooperative study. Arthritis Rheum 42:2325–2329CrossRefPubMedGoogle Scholar
  4. 4.
    Zochling J, van der Heijde D, Burgos-Vargas R, Collantes E, Davis JC Jr, Dijkmans B, Dougados M, Geher P, Inman RD, Khan MA, Kvien TK, Leirisalo-Repo M, Olivieri I, Pavelka K, Sieper J, Stucki G, Sturrock RD, van der Linden S, Wendling D, Bohm H, van Royen BJ, Braun J (2006) ASAS/EULAR recommendations for the management of ankylosing spondylitis. Ann Rheum Dis 65:442–452CrossRefPubMedGoogle Scholar
  5. 5.
    Braun J, Baraliakos X, Brandt J, Listing J, Zink A, Alten R, Burmester G, Gromnica-Ihle E, Kellner H, Schneider M, Sorensen H, Zeidler H, Sieper J (2005) Persistent clinical response to the anti-TNF-alpha antibody infliximab in patients with ankylosing spondylitis over 3 years. Rheumatology (Oxford) 44:670–676CrossRefGoogle Scholar
  6. 6.
    van der Heijde D, Kivitz A, Schiff MH, Sieper J, Dijkmans BA, Braun J, Dougados M, Reveille JD, Wong RL, Kupper H, Davis JC Jr (2006) Efficacy and safety of adalimumab in patients with ankylosing spondylitis: results of a multicenter, randomized, double-blind, placebo-controlled trial. Arthritis Rheum 54:2136–2146CrossRefPubMedGoogle Scholar
  7. 7.
    Davis JC Jr, Van Der Heijde D, Braun J, Dougados M, Cush J, Clegg DO, Kivitz A, Fleischmann R, Inman R, Tsuji W (2003) Recombinant human tumor necrosis factor receptor (etanercept) for treating ankylosing spondylitis: a randomized, controlled trial. Arthritis Rheum 48:3230–3236CrossRefPubMedGoogle Scholar
  8. 8.
    Calin A, Dijkmans BA, Emery P, Hakala M, Kalden J, Leirisalo-Repo M, Mola EM, Salvarani C, Sanmarti R, Sany J, Sibilia J, Sieper J, van der Linden S, Veys E, Appel AM, Fatenejad S (2004) Outcomes of a multicentre randomised clinical trial of etanercept to treat ankylosing spondylitis. Ann Rheum Dis 63:1594–1600CrossRefPubMedGoogle Scholar
  9. 9.
    Davis JC Jr, van der Heijde DM, Braun J, Dougados M, Clegg DO, Kivitz AJ, Fleischmann RM, Inman RD, Ni L, Lin SL, Tsuji WH (2008) Efficacy and safety of up to 192 weeks of etanercept therapy in patients with ankylosing spondylitis. Ann Rheum Dis 67:346–352CrossRefPubMedGoogle Scholar
  10. 10.
    Gorman JD, Sack KE, Davis JC Jr (2002) Treatment of ankylosing spondylitis by inhibition of tumor necrosis factor alpha. N Engl J Med 346:1349–1356CrossRefPubMedGoogle Scholar
  11. 11.
    van der Linden S, Valkenburg HA, Cats A (1984) Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum 27:361–368CrossRefPubMedGoogle Scholar
  12. 12.
    Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, Healey LA, Kaplan SR, Liang MH, Luthra HS et al (1988) The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 31:315–324CrossRefPubMedGoogle Scholar
  13. 13.
    Garrett S, Jenkinson T, Kennedy LG, Whitelock H, Gaisford P, Calin A (1994) A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol 21:2286–2291PubMedGoogle Scholar
  14. 14.
    Brandt J, Listing J, Haibel H, Sorensen H, Schwebig A, Rudwaleit M, Sieper J, Braun J (2005) Long-term efficacy and safety of etanercept after readministration in patients with active ankylosing spondylitis. Rheumatology (Oxford) 44:342–348CrossRefGoogle Scholar
  15. 15.
    van der Heijde D, Da Silva JC, Dougados M, Geher P, van der Horst-Bruinsma I, Juanola X, Olivieri I, Raeman F, Settas L, Sieper J, Szechinski J, Walker D, Boussuge MP, Wajdula JS, Paolozzi L, Fatenejad S (2006) Etanercept 50 mg once weekly is as effective as 25 mg twice weekly in patients with ankylosing spondylitis. Ann Rheum Dis 65:1572–1577CrossRefPubMedGoogle Scholar
  16. 16.
    Braun J, McHugh N, Singh A, Wajdula JS, Sato R (2007) Improvement in patient-reported outcomes for patients with ankylosing spondylitis treated with etanercept 50 mg once-weekly and 25 mg twice-weekly. Rheumatology (Oxford) 46:999–1004CrossRefGoogle Scholar
  17. 17.
    van der Heijde D, Landewe R, Einstein S, Ory P, Vosse D, Ni L, Lin SL, Tsuji W, Davis JC Jr (2008) Radiographic progression of ankylosing spondylitis after up to two years of treatment with etanercept. Arthritis Rheum 58:1324–1331CrossRefPubMedGoogle Scholar
  18. 18.
    Ara RM, Reynolds AV, Conway P (2007) The cost-effectiveness of etanercept in patients with severe ankylosing spondylitis in the UK. Rheumatology (Oxford) 46:1338–1344CrossRefGoogle Scholar
  19. 19.
    Brocq O, Millasseau E, Albert C, Grisot C, Flory P, Roux CH, Euller-Ziegler L (2009) Effect of discontinuing TNFalpha antagonist therapy in patients with remission of rheumatoid arthritis. Joint Bone Spine 76:350–355CrossRefPubMedGoogle Scholar
  20. 20.
    Lee SH, Lee YA, Hong SJ, Yang HI (2008) Etanercept 25 mg/week is effective enough to maintain remission for ankylosing spondylitis among Korean patients. Clin Rheumatol 27:179–181CrossRefPubMedGoogle Scholar
  21. 21.
    Brocq O, Roux CH, Albert C, Breuil V, Aknouche N, Ruitord S, Mousnier A, Euller-Ziegler L (2007) TNFalpha antagonist continuation rates in 442 patients with inflammatory joint disease. Joint Bone Spine 74:148–154CrossRefPubMedGoogle Scholar
  22. 22.
    Carmona L, Gomez-Reino JJ (2006) Survival of TNF antagonists in spondylarthritis is better than in rheumatoid arthritis. Data from the Spanish registry BIOBADASER. Arthritis Res Ther 8:R72CrossRefPubMedGoogle Scholar

Copyright information

© Clinical Rheumatology 2010

Authors and Affiliations

  • Jaejoon Lee
    • 1
  • Jung-Won Noh
    • 1
  • Ji Won Hwang
    • 1
  • Ji-Min Oh
    • 1
  • Hyungjin Kim
    • 1
  • Joong Kyong Ahn
    • 2
  • You Sun Lee
    • 3
  • Hoon-Suk Cha
    • 1
  • Eun-Mi Koh
    • 1
    Email author
  1. 1.Department of Medicine, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
  2. 2.Kangbuk Samsung HospitalSungkyunkwan University School of MedicineSeoulRepublic of Korea
  3. 3.Masan Samsung HospitalSungkyunkwan University School of MedicineSeoulRepublic of Korea

Personalised recommendations