Is Etanercept A Safe and Effective Treatment For Ankylosing Spondylitis?

Objective: The objective of this selective EBM review is to determine whether or not etanercept is a safe and effective treatment for ankylosing spondylitis (AS). Study Design: Review of three English language randomized control trials published in 2007, 2008, and 2010. Data Sources: Two double-blind placebo-controlled randomized controlled trials and one placebo-controlled randomized control trial comparing etanercept to placebo were found using PubMed. Outcomes Measured: Work instability was measured through the Ankylosing Spondylitis Work Instability Scale (AS-WIS) based on scores of 1-20. Quality of life was measured through the EuroQOL-5D (EQ-5D), which assesses mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Physical functioning was evaluated through the Bath Ankylosing Spondylitis Functioning Index (BASFI) where scores for functional limitation range from 1-100. Lastly, the safety and tolerability of etanercept were assessed based on personal reports from the patients themselves. Results: In a study by Barkham et al, etanercept treatment was not found improve work instabililty but not to the point of statistical significance. Risk of job loss was also decreased in those who received etanercept treatment. Quality of life was considerably improved with etanercept therapy as seen in a RCT by Braun et al. This study also illustrated statistically significant improvement in physical functioning in those who obtained etanercept verse placebo. Long-term treatment with etanercept for 192 weeks was shown to be safe and tolerable in a study conducted by Davis et al. The most common adverse effect of etanercept therapy was injection site reaction where more reactions were present compared with placebo. Conclusions: The results of two of the randomized control trials demonstrate etanercept to be a safe and effective treatment for ankylosing spondylitis. One randomized control trial does not reach statistical significance.