Experience with anti-tumor necrosis factor-α therapy in India

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AimsTo review the Indian experience with anti-tumor necrosis factor (TNF)-α therapy.Methods‘PubMed’ and ‘IndMED’ were searched for Indian studies on anti-TNF-α therapy. Data were compiled and analysed.ResultsData on infliximab from 176 patients from five different series were collated. One hundred and forty-seven had ankylosing spondylitis (AS), nine had polyarticular juvenile idiopathic arthritis (JIA), 12 had rheumatoid arthritis (RA), six had undifferentiated spondyloarthropathy, one had inflammatory bowel disease-related spondyloarthritis and one had psoriatic arthritis. Thus, 155/176. (88%) had spondyloarthropathy (SpA). No screening for latent tuberculosis was done in any of the studies. One series comprising 108 cases of AS, used 3 mg/kg infliximab infusions (instead of 5 mg/kg) at 8-weekly intervals with omission of the 2-week and 6-week doses. All others with SpA (n = 47) followed the standard protocol: 171/176 patients had a significant improvement. Reactivation tuberculosis developed in 5/47 (10.6%) SpA patients treated with standard doses of infliximab. This amounted to 56 times increased risk compared to baseline (0.187%). None of the 129 patients treated with 3 mg/kg infusions of infliximab developed reactivation tuberculosis (AS −108, RA −12, JIA −9). The lone study on etanercept showed good efficacy in 40 patients with RA. However, seven serious adverse events occurred.ConclusionsInfliximab showed expected efficacy in SpA, RA and JIA. Reactivation tuberculosis developed in 10.6% of the SpA group treated with standard regimen. Patients treated with lower doses of infliximab which included a large subgroup of SpA patients and those with RA or JIA did not develop tuberculosis.

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