Department of Rheumatology, Jan van Breemen Research Institute|Reade, Amsterdam, The Netherlands.
Laboratory for Monoclonal Therapeutics, Sanquin Diagnostic Services, Amsterdam, The Netherlands.
Ann Rheum Dis. 2015 Oct;74(10):1825-9. doi: 10.1136/annrheumdis-2014-205213. Epub 2014 May 7.
Previous data have shown that etanercept levels are associated with clinical response in rheumatoid arthritis. However, for ankylosing spondylitis (AS), data regarding this topic are inconclusive.
To investigate the relationship between etanercept levels and clinical response in patients with AS.
Observational prospective cohort study of 162 patients with AS =treated with etanercept, monitored during 24 weeks of treatment. Etanercept trough levels were determined, retrospectively, using an ELISA. Disease activity was measured using AS Disease Activity Score (ASDAS), including C-reactive protein (CRP) and Bath AS Disease Activity index (BASDAI). Active disease was defined as ASDAS≥2.1. Since etanercept is a drug administered at home there might have been some variation in trough level sampling.
At 24 weeks etanercept levels were significantly higher in patients with ASDAS<2.1, (3.8 mg/L; IQR 2.5-5.2) compared with patients with ASDAS≥2.1 (2.3 mg/L; IQR 1.2-3.4; p≤0.001). Generalised estimating equation analysis demonstrated a statistically significant association between etanercept levels and ASDAS, BASDAI, CRP and erythrocyte sedimentation rate (all p<0.001). When patients were categorised into quartiles according to etanercept levels, the lowest quartile (etanercept<1.80 mg/L) comprised 35% of all patients with ASDAS≥2.1 while the highest quartile comprised only 14%.
Disease activity and inflammation are associated with etanercept levels in patients with AS at 24 weeks of treatment. Measuring etanercept levels might help in identifying overtreatment and undertreatment and optimise etanercept therapy in AS.
先前的数据表明，依那西普水平与类风湿关节炎的临床反应相关。然而，对于强直性脊柱炎（AS），关于这个主题的数据尚无定论。
研究 AS 患者依那西普水平与临床反应之间的关系。
这是一项观察性前瞻性队列研究，纳入 162 例接受依那西普治疗的 AS 患者，在 24 周的治疗期间进行监测。使用 ELISA 回顾性地测定依那西普的谷浓度。使用 AS 疾病活动评分（ASDAS），包括 C 反应蛋白（CRP）和 Bath AS 疾病活动指数（BASDAI）来衡量疾病活动度。将 ASDAS≥2.1 定义为活动性疾病。由于依那西普是一种在家中给药的药物，因此谷浓度采样可能存在一些差异。
在 24 周时，ASDAS<2.1 的患者的依那西普水平显著高于 ASDAS≥2.1 的患者（3.8mg/L；IQR 2.5-5.2）（p≤0.001）。广义估计方程分析表明，依那西普水平与 ASDAS、BASDAI、CRP 和红细胞沉降率之间存在统计学显著关联（均 p<0.001）。当根据依那西普水平将患者分为四分位组时，最低四分位组（依那西普<1.80mg/L）包含了所有 ASDAS≥2.1 的患者中的 35%，而最高四分位组仅包含 14%。
在接受 24 周依那西普治疗的 AS 患者中，疾病活动度和炎症与依那西普水平相关。测量依那西普水平可能有助于识别过度治疗和治疗不足，并优化 AS 中的依那西普治疗。
