2-year Follow-up Study Of Peripheral Joint Dmards Treatment Of Ankylosing Spondylitis, Etanercept Dose Decreasing

OBJECTIVE:To evaluate the long-term efficacy of reduced-dose schedule of etanercept combined with DMARDs in the treatment of ankylosing spondylitis with peripheral joints involved, in order to provide the evidence based foundation for clinical use of reduced schedule of etanercept.MATERIALS AND METHODS:113 patients with peripheral ankylosing spondylitis were randomized by 2:1 ratio into two groups:the test group received reduced-dose schedule of etanercept (25mg, qw×4 times; subsequently changed to 12.5mg, qw×4 times; and then 12.5mg, q10d×6 times; at last 12.5mg, q15d, by subcutaneous injection) combined with methotrexate (MTX,7.5mg, qw, oral)+Salazosulfadimidine (SSZ, 1g, bid, oral) or with MTX+Thalidomide (Thal, 100mg, qn, oral) or with MTX+SSZ+Thal. The control group received combination of MTX+SSZ or MTX+Thal or MTX+SSZ+Thal. The clinical indices and radiological changes were compared between the groups at baseline and after 2 year of therapy.RESUITS:Compared with traditional DMARDs combination, reduced-dose schedule of etanercept with DMARDs showed better efficacy in improving clinical back pain, morning stiffness, BASDAI and BASFI, ESR and CRP (P<0.05),and also had a higher ratio of patients reaching ASAS20 and ASAS50 (P<0.05). The CT grading of sacroiliac joints and the X radiography grading of knee and ankle joints also demonstrated a marked inhibition of bone erosine after 2-year treatment with reduced-dose schedule of etanercept when compared with baseline grading. After 2-year treatment, reduced-etanercept schedule showed a better inhibiton of bone erosines than traditional DMARDs in the CT of sacroiliac joints and the X radiography of knee and ankle joints(P<0.05). No severe side effects occurred in the 2-year duration of treatment.CONCIUSION:Reduced-dose schedule of etanercept combined with DMARDs can relieve the axial and peripheral symptoms of AS, improve patient's joint function and inhibit the progression of joint erosine more effectively than traditional DMARDs schedule. And moreover, Reduced-dose schedule of etanercept is also safety and economical for better compliance of patients.