Adalimumab efficacy in enteropathic spondyloarthritis: A 12-mo observational multidisciplinary study

Figure 1 Therapeutic algorithm of the ES-AN patient cohort at the time of entry into the study. A: ES patients biological drugs-naïve were treated depending on IBD activity and site of the articular involvement, as follows: a) Ax-ES-AN with Ada as the TNF-inhibitor in first-line therapy, due to the absolute contraindication for a long-course treatment with NSAIDs in cases of IBDs; b) Per-ES-AN in cases of active IBD and in those patients who were non-responders to short-course corticosteroid treatment (not > 3 mo) or NSAIDs (not > 2 wk), with DMARD (methotrexate or sulfasalazine), or in cases of ESR > 30 mm/h and/or CRP > 0.5 mg/dL, and polyarticular inflammatory involvement with Ada; c) Per-ES-AN in inactive IBD, with steroids or DMARDs, depending on the number of inflamed joints and systemic inflammation (evaluated by ESR and/or CRP); B: ES patients already in treatment with infliximab for the IBD. In the ES-AN patients already treated with IFX: a) Per-ES-AN with active IBD were switched to Ada; b) Per-ES-AN with IBD in remission received a DMARD in addition to the IFX already in use; c) Ax-ES-AS were switched to Ada, regardless of IBD activity. Dashed line: Patients refractory to therapy. Therapeutic doses: DMARDs were prescribed at the standard dose regimens (salazopyrine 2 gr bid; methotrexate 10-20 mg once a week); Ada was used following the therapeutic dosage and indications for IBDs (160 mg at d 1 and 80 mg after 2 wk, followed by 40 mg every 2 wk). Ada: Adalimumab; AX-ES-AN: Patients with axial spondyloarthritis in the ES-AN cohort; CRP: C-reactive protein; ES: Enteropathic spondyloarthritis; ES-AN: Patients affected by ES in the Ancona’s cohort; ESR: Erythrocyte sedimentation rate: DMARD: Disease modifying anti-rheumatic drug; IBD: Inflammatory bowel disease; NSAID: Non-steroidal anti-inflammatory drug; Per-ES-AN: Patients with peripheral spondyloarthritis in the ES-AN cohort.