Efficacy of antitumor necrosis factor(α) agents on patients with ankylosing spondylitis.

OBJECTIVES:

This study was designed to investigate the efficacy of antitumor necrosis factor(TNF)(a) agents (etanercept, infliximab, golimumab or adalimumab) in ankylosing spondylitis (AS).

METHODS:

A literature search was done using PubMed, Embaseand Cochrane databases. The reference section of all primary studies was inspected for additional references, and only those reporting the results of a randomized-controlled trial comparing etanercept, infliximab or adalimumab with placebo for patients with AS were included in this analysis.

RESULTS:

Eleven trials with 1851 patients were included. Compared with placebo, anti-TNF(α) agents was associated with significantly higher rates of Assessment in Ankylosing Spondylitis (ASAS) 20 responders (risk ratio [RR]: 2.45, 95% confidence interval [CI]: 2.13-2.82; P < 0.00001), ASAS 50 responders (RR: 3.77, 95% CI.: 2.87-4.95; P < 0.00001), ASAS 70 responders (RR: 3.25, 95% CI.: 1.97-5.35; P < 0.00001) and patients with partial remission (RR: 5.39, 95% CI.: 3.25-8.93; P < 0.00001). In addition, there were more patients with at least 50% improvement in the Bath Ankylosing Spondylitis Disease Activity Index score in the experimental groups (RR: 3.07, 95% CI.: 2.44-3.86; P < 0.00001). Most adverse events in both treatment groups were mild or moderate in severity.

CONCLUSIONS:

Anti-TNF(a) agents is an effective and well-tolerated treatment for reducing clinical symptoms of AS.