ABSTRACT
The rationale of the study was to evaluate the efficacy of infliximab (IFX) treatment in patients with ankylosing spondylitis (AS) and to determine whether IFX dose reduction and interval extension sustains the treatment effect. Nineteen patients were included and treated with IFX 5 mg/kg every 6 weeks for 56 weeks. All patients concomitantly received MTX with median dose 7.5 mg/weekly. During the second year, the IFX dose was reduced to 3 mg/kg every 8 weeks. Eighteen patients completed the 1-year and 15 patients the 2-year trial. The ≥50% improvement at week 16 from baseline of BASDAI was achieved in 16/19 (84%) patients. Significant reductions in BASDAI, BASFI, and BASMI scores, decrease in ESR and CRP, and improvement in SF-36 were observed at weeks 16 and 56. The MRI-defined inflammatory changes in the sacroiliac joints disappeared in 10/15 patients (67%) already at 16 weeks. IFX treatment effect was sustained throughout the second year after IFX dose reduction and interval extension. We conclude that IFX treatment is effective in well-established active AS and a dose reduction sustains the treatment effect. These observations are of clinical importance and open the opportunity to reduce the drug costs.
Subject(s)
Antibodies, Monoclonal/administration & dosage , HLA-B27 Antigen/metabolism , Spondylitis, Ankylosing/drug therapy , Spondylitis, Ankylosing/metabolism , Adult , Antirheumatic Agents/administration & dosage , Dose-Response Relationship, Drug , Drug Administration Schedule , Female , Humans , Inflammation/metabolism , Infliximab , Magnetic Resonance Imaging , Male , Methotrexate/administration & dosage , Middle Aged , Pilot Projects , Prospective Studies , Quality of Life , Sacroiliac Joint/drug effects , Sacroiliac Joint/pathology , Time FactorsABSTRACT
PURPOSE: The aim of this paper is to investigate how waiting lists or queues could be reduced without adding more resources; and to describe what factors sustain reduced waiting-times. DESIGN/METHODOLOGY/APPROACH: Cases were selected according to successful and sustained queue reduction. The approach in this study is action research. FINDINGS: Accessibility improved as out-patient waiting lists for two clinics were reduced. The main success was working towards matching demand and capacity. It has been possible to sustain the improvements. RESEARCH LIMITATIONS/IMPLICATIONS: Results should be viewed cautiously. Transferring and generalizing outcomes from this study is for readers to consider. However, accessible healthcare may be possible by paying more attention to existing solutions. PRACTICAL IMPLICATIONS: The study indicates that queue reduction activities should include acquiring knowledge about theories and methods to improve accessibility, finding ways to monitor varying demand and capacity, and to improve patient processing by reducing variations. ORIGINALITY/VALUE: Accessibility is considered an important dimension when measuring service quality. However, there are few articles on how clinic staff sustain reduces waiting lists. This paper contributes accessible knowledge to the field.
