Treating ankylosing spondylitis (AS) is costly, even in high-income nations. In lower-income countries, patients may face serious challenges in accessing high-cost drugs, like anti–tumor necrosis factor agents, even when biosimilars are available.
Treating ankylosing spondylitis (AS) is costly, even in high-income nations. In lower-income countries, patients may face serious challenges in accessing high-cost drugs, like anti—tumor necrosis factor (TNF) agents, even when biosimilars are available.
Reduced Doses of Adalimumab and Cost-Effectiveness
During the 20th Asia Pacific League of Associations for Rheumatology (APLAR) Congress, held September 6 to 9 in Kaohsiung, Taiwan, researchers from the Apollo Gleneagles Hospital in India reported on a study assessing the efficacy and safety of an altered adalimumab dosing program for patients with AS that sought to reduce patient costs.1
The retrospective analysis examined records for 28 patients with AS who were receiving biosimilar adalimumab at a dose of 40 mg twice per month for 48 weeks, and who were then transitioned to a once-monthly dose for 24 weeks as a way to reduce financial strain.
The investigators found that the altered regimen was associated with continued reductions in Health Assesment Questionnaire scores and pain scores, which indicated sustained improvement. According to the investigators, the sustained efficacy of biosimilar adalimumab on a reduced dosing schedule suggests that this approach may be a cost-effective way to treat patients with AS.
New Directions in Treating AS
Despite anti-TNF therapies’ effectiveness in treating some patients with AS, approximately one-third of patients treated with anti-TNF agents show only a poor response and discontinue treatment, and women have a lower anti-TNF retention rate than men. Taken to gether, these facts suggest that alternative therapies are be needed in this disease state.
While interleukin-17 (IL-17) inhibition has been demonstrated to be effective in treating AS, and an ongoing head-to-head trial of biosimilar adalimumab and the IL-17 inhibitor secukinumab may help to clarity the treatment paradigm for AS, new findings suggest that IL-6 inhibition may also be a useful target.
Elevated levels of IL-6 in patients with AS have been observed, through the IL-6 inhibitor tocilizumab has not been demonstrated to be effective in treating AS in clinical trials. However, explained Japanese researchers, also at the APLAR conference, the effect of an IL-6 receptor antibody in treating mice with AS has now been demonstrated.2
The researchers reported that a specific strain of mice—RA1—spontaneously develop AS, and these mice were used to demonstrate the efficacy of an IL-6 inhibitor in treating the disease. Male mice were divided into groups, 1 of which received an antibody, MR 16-1, and the other of which received placebo, every 2 weeks. Tissue was evaluated at 4, 7, and 10 weeks of treatment, and the histological score of treated mice was significantly improved at every time point.
According to the researchers, the IL-6 receptor antibody is effective for treating AS in mice, and may be a potential new treatment for patients.
1. Bandyopadhyay S, Ghosh S. Efficacy and safety of an altered dose of biosimilar adalimumab after the initial recommended therapy in patients with ankylosing spondylitis. Presented at the Asia Pacific League of Associations for Rheumatology Congress, September 6-9, 2018; Kaohsiung, Taiwan. Abstract SU143. doi: 10.1111/1756-185X.13361.
2. Izumiyama T, Mori Y, Mori S, Takeda K, Kodama T, Itoi E. The effect of IL-6 receptor antibody for the treatment of McH-Ipr/Ipr-RA1 mice that spontaneously develop ankylosing arthritis. Presented at the Asia Pacific League of Associations for Rheumatology Congress, September 6-9, 2018; Kaohsiung, Taiwan. Abstract SU022. doi: 10.1111/1756-185X.13361.