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Thalidomide reduces recurrence of ankylosing spondylitis in patients following discontinuation of etanercept

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A previous study showed that most ankylosing spondylitis (AS) patients presented recurrence within 6 months post-discontinuation of etanercept. How to reduce recurrence following discontinuation of etanercept should be further researched. In this study, 111 ankylosing spondylitis patients meeting the Assessment in AS 20 % response (ASAS20) criteria after 12-week administration of etanercept were randomized into three groups: Group I, 150 mg thalidomide once/day; Group II, 1 g sulfasalazine, twice/day; Group III, NSAIDs for the maintenance treatment. The patients were regularly followed up once a month, and AS recurrence was evaluated with the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Functional Index (BASFI), the patient global assessment (PGA), and rachialgia. The follow-up lasted for 1 year, and AS recurrence was considered as the end of a visit. Finally, 100 patients completed the follow-up study, of whom 30 were in Group I, 33 in Group II, and 37 in Group III. The average follow-up period was 5.1 ± 3.9 months and the longest lasted for 12 months. At the end of the follow-up study, the recurrence rates in Groups I, II, and III were, respectively, 60.0 % (18/30), 84.8 % (28/33), and 89.2 % (33/37). The recurrence rates of Group I were statistically significantly lower than that of Group II and III (P = 0.0265; P = 0.0053), while there was no significant difference between Group II and Group III. In addition, we found that PGA, C-reactive protein (CRP), and spinal inflammation could be regarded as predictive factors for AS recurrence by analysis with the Cox proportional hazard model. This study points to a new way for maintenance therapy of AS following discontinuation of etanercept and reveals several useful indicators for prediction of AS recurrence.

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  1. Silva EM, Andrade SC, Vilar MJ (2011) Evaluation of the effects of Global Postural Reeducation in patients with ankylosing spondylitis. Rheumatol Int 32:2155–2163

    Article  PubMed  Google Scholar 

  2. Zink A, Braun J, Listing J, Wollenhaupt J (2000) Disability and handicap in rheumatoid arthritis and ankylosing spondylitis—results from the German rheumatological database. German Collaborative Arthritis Centers. J Rheumatol 27:613

    CAS  PubMed  Google Scholar 

  3. Goh L, Samanta A (2009) A systematic medline analysis of therapeutic approaches in ankylosing spondylitis. Rheumatol Int 29:1123–1135

    Article  CAS  PubMed  Google Scholar 

  4. Brandt J, Khariouzov A, Listing J, Haibel H, Sörensen H, Grassnickel L, Rudwaleit M, Sieper J, Braun J (2003) Six-month results of a double-blind, placebo-controlled trial of etanercept treatment in patients with active ankylosing spondylitis. Arthritis Rheum 48:1667–1675

    Article  CAS  PubMed  Google Scholar 

  5. Giardina AR, Ferrante A, Ciccia F, Impastato R, Miceli MC, Principato A, Triolo G (2010) A 2-year comparative open label randomized study of efficacy and safety of etanercept and infliximab in patients with ankylosing spondylitis. Rheumatol Int 30:1437–1440

    Article  PubMed  Google Scholar 

  6. Brandt J, Listing J, Haibel H, Sörensen 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 44:342–348

    Article  CAS  PubMed  Google Scholar 

  7. Moghimi J, Sheikhvatan M, Semnani V (2011) The use of low-dose etanercept as an alternative therapy for treatment of ankylosing spondylitis: a case series. Rheumatol Int 32:2271–2274

    Article  PubMed  Google Scholar 

  8. Lian F, Yang X, Liang L, Xu H, Zhan Z, Qiu Q, Ye Y (2011) Treatment efficacy of etanercept and MTX combination therapy for ankylosing spondylitis hip joint lesion in Chinese population. Rheumatol Int 32:1663–1667

    Article  PubMed  Google Scholar 

  9. Ferraz MB, Tugwell P, Goldsmith C, Atra E (1990) Meta-analysis of sulfasalazine in ankylosing spondylitis. J Rheumatol 17:1482

    CAS  PubMed  Google Scholar 

  10. Clegg DO, Reda DJ, Weisman MH, Blackburn WD, Cush JJ, Cannon GW, Mahowald ML, Schumacher HR Jr, Taylor T, Budiman-Mak E (1996) Comparison of sulfasalazine and placebo in the treatment of ankylosing spondylitis. A Department of Veterans Affairs Cooperative Study. Arthritis Rheum 39:2004–2012

    Article  CAS  PubMed  Google Scholar 

  11. Huang F, Wei J, Breban M (2002) Thalidomide in ankylosing spondylitis. Clinical and experimental rheumatology 20:158–161

  12. Wei JCC, Chan TW, Lin HS, Huang F, Chou CT (2003) Thalidomide for severe refractory ankylosing spondylitis: a 6-month open-label trial. J Rheumatol 30:2627–2631

    CAS  PubMed  Google Scholar 

  13. Davis JC, Huang F, Maksymowych W (2003) New therapies for ankylosing spondylitis: etanercept, thalidomide, and pamidronate. Rheum Dis Clin North Am 29:481–494

    Article  PubMed  Google Scholar 

  14. 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

    CAS  PubMed  Google Scholar 

  15. Stone MA, Inman RD, Wright JG, Maetzel A (2004) Validation exercise of the Ankylosing Spondylitis Assessment Study (ASAS) group response criteria in ankylosing spondylitis patients treated with biologics. Arthritis Care Res (Hoboken) 51:316–320

    Article  CAS  Google Scholar 

  16. Baraliakos X, Brandt J, Listing J, Haibel H, Sörensen H, Rudwaleit M, Sieper J, Braun J (2005) Outcome of patients with active ankylosing spondylitis after two years of therapy with etanercept: clinical and magnetic resonance imaging data. Arthritis Care Res (Hoboken) 53:856–863

    Article  CAS  Google Scholar 

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Correspondence to Jianglin Zhang.

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Deng, X., Zhang, J., Zhang, J. et al. Thalidomide reduces recurrence of ankylosing spondylitis in patients following discontinuation of etanercept. Rheumatol Int 33, 1409–1413 (2013).

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