| Objective In the present study,we focus on exploring the potential differences between ankylosing spondylitis(AS)patients receiving first-course of TNF? inhibitors(TNFi)and patients receiving a second-course of TNFi if they stopped therapy in drug efficacy and safety.Meanwhile,a study on TNFi reduction schemes applicable to AS patients is also assessed.Methods A total of 135 AS patients admitted into Lanzhou University Second Hospital ranging from Oct 2016 to Aug 2018 were enrolled.At the end of 12 weeks,all the patients were divided into two groups with patients initially treated with TNFi therapy as well as patients receiving a second-course of TNFi therapy if they stopped treatment in the first course.The drug efficacy and safety was compared in two groups.Subsequently,a personalized reduction theme study of TNFi was designed for each patient to observe all the parameters until 48 weeks.T-test,chi-square test and covariance analysis were used to determine the significance of the values.Results At the 12 th week,the efficacy indexes of the two groups were significantly improved after treatment,and the difference was statistically significant compared with the baseline(P<0.05).For those receiving first-course of TNFi therapy,the erythrocyte sedimentation rate(ESR,mm/h)was 43.96 ± 28.02 before treatment and 7.68 ± 7.11 after treatment.The C-reactive protein(CRP,mg/L)was 34.32 ± 31.36 before treatment and 4.91 ± 6.77 after treatment.Visual analogue scale(VAS)for pain was 6.82 ± 1.47 in patients before treatment and 1.96 ± 1.41 after treatment;the time of morning stiffness(h)was 0.67 ± 0.44 and 0.12 ± 0.16,respectively.The bath AS disease activity index(BASDAI)was 5.09 ± 1.15 before treatment,which was much higher than after treatment with 1.54 ± 1.00.The same trend was observed in bath ankylosing spondylitis functional index(BASFI)[3.73 ± 1.93 VS 1.38 ± 1.03],bath ankylosing spondylitis metrology index(BASMI)[2.53 ± 1.58 VS 0.93 ± 0.82] and ankylosing spondylitis disease activity score(ASDAS)[3.77 ± 0.81 VS 1.30 ± 0.60].In terms of patients re-initiating TNFi therapy,a significant difference was observed before treatment and after treatment in ESR(mm/h)[44.25 ± 29.00 VS 8.46 ± 9.07],CRP(mg/L)[35.07 ± 28.03 VS 4.36 ± 5.29],VAS [6.75 ± 1.63 VS 1.78 ± 0.99],the time of morning stiffness(h)[0.68 ± 0.4 VS 0.13 ± 0.14],BASDAI [5.16 ±0.76 VS 1.41 ± 1.18],BASFI [4.61 ± 2.09 VS 1.31 ± 1.16],BASMI [3.21 ± 1.59 VS 1.03 ± 0.82]and ASDAS [3.85 ± 0.81 VS 24 ± 0.38].There was no statistically significant difference between the two groups(P>0.05).The difference between the efficacy indicators at each time point after the start of reduction was not statistically significant(P>0.05).Conclusion Patients with AS who re-initiated TNFi therapy after discontinuation could achieve comparable drug efficacy and safety when compared to those who received the treatment in the first time,indicating that it is promising to designed personalized dose reduction program for AS patients. |
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