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. 2018 Jan;77(1):63-69.
doi: 10.1136/annrheumdis-2017-211544. Epub 2017 Sep 22.

TNF Blockers Inhibit Spinal Radiographic Progression in Ankylosing Spondylitis by Reducing Disease Activity: Results From the Swiss Clinical Quality Management Cohort

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Free PMC article

TNF Blockers Inhibit Spinal Radiographic Progression in Ankylosing Spondylitis by Reducing Disease Activity: Results From the Swiss Clinical Quality Management Cohort

Christoph Molnar et al. Ann Rheum Dis. .
Free PMC article

Abstract

Objectives: To analyse the impact of tumour necrosis factor inhibitors (TNFis) on spinal radiographic progression in ankylosing spondylitis (AS).

Methods: Patients with AS in the Swiss Clinical Quality Management cohort with up to 10 years of follow-up and radiographic assessments every 2 years were included. Radiographs were scored by two readers according to the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) with known chronology. The relationship between TNFi use before a 2-year radiographic interval and progression within the interval was investigated using binomial generalised estimating equation models with adjustment for potential confounding and multiple imputation of missing values. Ankylosing Spondylitis Disease Activity Score (ASDAS) was regarded as mediating the effect of TNFi on progression and added to the model in a sensitivity analysis.

Results: A total of 432 patients with AS contributed to data for 616 radiographic intervals. Radiographic progression was defined as an increase in ≥2 mSASSS units in 2 years. Mean (SD) mSASSS increase was 0.9 (2.6) units in 2 years. Prior use of TNFi reduced the odds of progression by 50% (OR 0.50, 95% CI 0.28 to 0.88) in the multivariable analysis. While no direct effect of TNFi on progression was present in an analysis including time-varying ASDAS (OR 0.61, 95% CI 0.34 to 1.08), the indirect effect, via a reduction in ASDAS, was statistically significant (OR 0.75, 95% CI 0.59 to 0.97).

Conclusion: TNFis are associated with a reduction of spinal radiographic progression in patients with AS. This effect seems mediated through the inhibiting effect of TNFi on disease activity.

Keywords: ankylosing spondylitis; anti-tnf; epidemiology.

Conflict of interest statement

Competing interests: JB has received consulting fees from Merck Sharp & Dohme, Pfizer and Roche. AC has received consulting and/or speaking fees from AbbVie, Celgene, Eli Lilly, Janssen-Cilag, Merck Sharp & Dohme, Novartis, Pfizer and UCB. MJN has received consulting and/or speaking fees from Abbvie, Novartis and Pfizer. DvdH has received consulting fees from Abbvie, Amgen, Astellas, AstraZeneca, BMS, Boeringer Ingelheim, Celgene, Daiichi, Eli-Lilly, Galapagos, Gilead, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi and UCB and is director of Imaging Rheumatology BV. UW has received speaking fees from AbbVie. AS, GT, LMW, MC, MdH, PE, PZ, RBML, RK, RM and XBdeclare no conflict of interest. No non-financial conflicts of interest exist for any of the authors.

Figures

Figure 1
Figure 1
Multivariable analysis of 616 radiographic intervals from 432 patients after multiple imputation of missing covariate data for the identification of factors associated with (A) radiographic progression defined as an increase of ≥2 mSASSS units per 2 years and (B) radiographic progression defined as the formation of at least one new syndesmophyte per 2 years. Analysis performed in 616 radiographic intervals from 432 patients after multiple imputation of missing covariate data. BMI, body mass index; HLA-B27, human leucocyte antigen B27; mSASSS, modified Stoke Ankylosing Spondylitis Spine Score; NSAIDs, non-steroidal anti-inflammatory drugs; Ref, reference; TNFi, tumour necrosis factor inhibitor. *mSASSS at start of each 2-year radiographic interval in A and presence of syndesmophytes at start of each 2-year radiographic interval (yes vs no) in B.
Figure 2
Figure 2
Cumulative probability plot of 2-year progression in the modified Stoke Ankylosing Spine Score (mSASSS), illustrating the change in mSASSS values from baseline of each individual radiographic interval to 2 years in patients already treated with TNFi at start of the respective interval, stratified by the ASDAS cut-off level reached at the beginning of each radiographic interval: ASDAS >2.1 (n=111, 136 radiographic intervals), ASDAS >1.3 and ≤2.1 (n=68, 85 radiographic intervals) and ASDAS ≤1.3 (inactive disease status; n=40, 48 radiographic intervals). Radiographic progression was defined as an increase in mSASSS of ≥2 in 2 years (dotted line). ASDAS, Ankylosing Spondylitis Disease Activity Score.

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References

    1. Sepriano A, Regel A, van der Heijde D, et al. Efficacy and safety of biological and targeted-synthetic DMARDs: a systematic literature review informing the 2016 update of the ASAS/EULAR recommendations for the management of axial spondyloarthritis. RMD Open 2017;3:e000396 10.1136/rmdopen-2016-000396 - DOI - PMC - PubMed
    1. Machado P, Landewé R, Braun J, et al. Both structural damage and inflammation of the spine contribute to impairment of spinal mobility in patients with ankylosing spondylitis. Ann Rheum Dis 2010;69:1465–70. 10.1136/ard.2009.124206 - DOI - PubMed
    1. Poddubnyy D, Sieper J. Radiographic progression in ankylosing spondylitis/axial spondyloarthritis: how fast and how clinically meaningful? Curr Opin Rheumatol 2012;24:363–9. 10.1097/BOR.0b013e328352b7bd - DOI - PubMed
    1. Ramiro S, van der Heijde D, van Tubergen A, et al. Higher disease activity leads to more structural damage in the spine in ankylosing spondylitis: 12-year longitudinal data from the OASIS cohort. Ann Rheum Dis 2014;73:1455–61. 10.1136/annrheumdis-2014-205178 - DOI - PubMed
    1. Poddubnyy D, Protopopov M, Haibel H, et al. High disease activity according to the ankylosing spondylitis disease activity score is associated with accelerated radiographic spinal progression in patients with early axial spondyloarthritis: results from the German Spondyloarthritis Inception Cohort. Ann Rheum Dis 2016;75:2114–8. 10.1136/annrheumdis-2016-209209 - DOI - PubMed

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