Interrupted course of antitumor necrosis factor alpha therapy versus combined nonsteroidal anti-inflammatory drug therapy and physiotherapy in patients with ankylosing spondylitis: A comparative study

Abstract

Aim The aim was to evaluate the efficacy of interrupted course of antitumor necrosis factor alpha (TNF-α) blocking agents (etanercept and adalimumab) as 3-month-on-and-3-month-off regimen versus combined regimen of physiotherapy and NSAIDs in patients with ankylosing spondylitis (AS) within a 2-year period. Patients and methods A total of 60 patients who fulfilled the Modified New York Criteria for AS were enrolled in the current study and divided into two equal groups: one received interrupted course of anti-TNFα agents and one received NSAIDs plus physiotherapy. Both groups were subjected to follow-ups at 6, 12, 18, and 24 months. To assess the response, Ankylosing Spondylitis Disease Activity Scores (ASDAS-ESR and ASDAS-CRP) were used, in addition to Bath Ankylosing Spondylitis Disease Activity Index (BASDI), Bath Ankylosing Spondylitis Functional Index (BASFI), and Bath AS Metrology Index (BASMI). Modified stock Ankylosing Spondylitis Spine Score (M-SASSS) was used to assess the radiological progression. Results The authors found significantly higher improvement in the patient group treated by intermittent course of anti-TNFα agents relative to the other group regarding inflammatory markers, disease activity, and functional index during follow-up. Although there was a significant radiographic progression regarding M-SASSS values in anti-TNFα therapy patients, these values were lower than NSAID patient group. Conclusion Patients with AS can follow regular intermittent course (3 months on and 3 months off) of anti-TNFα blocking agents such as etanercept and adalimumab with possible efficacy and safety. This regimen was found to be successful in improving disease activity and functional impairment in those patients when compared with patients maintained on NSAIDs and physiotherapy.