Kamps, F.B.S. (2012) Dose reduction of tumor necrosis factor alpha blocking agents based on expert opinion is possible in patients with ankylosing spondylitis. thesis, Medicine.
Full text available on request.Abstract
Introduction: Ankylosing Spondylitis (AS) or Bechterew’s disease, is a chronic, inflammatory rheumatic disease, which mainly affects the axial skeleton and the sacroiliac joints. When conventional treatment with physiotherapy and non-steroidal anti-inflammatory drugs (NSAIDs) is insufficient, treatment with tumor necrosis factor alpha (TNF-α) blocking agents can be considered. Randomized controlled trials (RCT) have shown that TNF-α blocking agents are effective in reducing the signs and symptoms of AS. However, the use of TNF-α blocking agents has its limitations concerning the high costs and the possible side effects. The aim of this study is to investigate whether dose reduction of TNF-α blocking agents based on expert opinion is possible in AS patients. Methods: This retrospective study included AS patients who had started dose reduction of TNF-α blocking agents based on expert opinion at the University Medical Centre Groningen (UMCG) and Medical Centre Leeuwarden (MCL). These patients were divided into two groups: group 1 consisted of patients with stable AS and/ or low disease activity and group 2 of patients with other reasons of dose reduction, including side effects. The number of AS patients maintaining on dose reduction was investigated at 6, 12, 18 and 24 months. Besides, the extent of dose reduction was investigated. The mean survival time of dose reduction during the entire follow-up was analyzed, as well as data regarding disease activity, physical function and quality of life of patients who succeeded in dose reduction. Results: Between November 2005 and January 2011, 89 AS patients ( group 1 n¬= 60, group 2 n= 29) treated with TNF-α blocking agents had started with dose reduction based on expert opinion. In total 74%, 58%, 49% and 43% of the patients maintained on dose reduction at 6, 12, 18 and 24 months, respectively. The median extent of dose reduction was 40%. Comparable percentages and extent of dose reduction were found in group 1 and 2. The mean survival time of dose reduction was 33 months. Clinical assessments regarding disease activity, physical function and quality of life remained stable during follow-up. Conclusion: Dose reduction of TNF-α blocking agents in AS patients based on expert opinion is possible in daily clinical practice, without relevant deteriorations in the clinical assessments.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Faculty supervisor: and Brouwer, dr. E. |
| Supervisor name: | External supervisors: and Arends, drs. S. and and Veer, dr. E. van der and University Medical Centre Groningen, department of Rheumatol |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:55 |
| Last Modified: | 25 Jun 2020 10:55 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1547 |
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