Biologic therapy and spinal radiographic progression in patients with axial spondyloarthritis: A structured literature review

Abstract

We aimed to perform a structured literature review of spinal radiographic progression, as assessed by the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS), in patients with ankylosing spondylitis (AS) or nonradiographic axial spondyloarthritis (nr-axSpA) treated with biologic therapy. Searches were limited to English language manuscripts published in the 11 years prior to 9 July 2019. Randomized controlled trials, open-label extensions (OLEs) and observational studies reporting mSASSS progression in patients with AS or nr-axSpA treated with biologics were eligible for inclusion. Bias was assessed using the methodological index for nonrandomized studies (MINORS) tool. Among the 322 studies identified in the literature search, 23 (11 OLEs and 12 cohort studies) met the eligibility criteria and were selected for inclusion. Most studies reported mSASSS progression in patients with AS receiving tumor necrosis factor inhibitor (TNFi) treatment. One study reported mSASSS progression in patients with AS treated with secukinumab, an interleukin-17A inhibitor. The mean (range) MINORS score was 11.3 (7-15) for the 15 noncomparative studies and 15 (12-22) for the 8 comparative studies. Although results of the individual studies were variable, mSASSS progression in patients with AS was generally minimal and slow with long-term TNFi therapy. Moreover, odds ratios for the likelihood of mSASSS progression with/without TNFi favoured TNFi therapy in several of the cohort studies. The rate of mSASSS progression following continuous secukinumab treatment was low and remained stable over 4 years. Of two studies reporting progression in patients with nr-axSpA treated with TNFis, one showed no mSASSS progression; however, the lack of control limited comparative conclusions.

Conventional disease-modifying antirheumatic drugs therapy may not slow spinal radiographic progression in ankylosing spondylitis: results from an 18-year longitudinal dataset

“…Meanwhile, according to two recent systematic reviews concerning the effect of therapy on radiographic progression, mean mSASSS change varied considerably between studies. 20 , 21 Because different follow-up durations and different data-management approaches can heavily influence outcomes, especially given the slowly progressing nature and heterogeneity of AS and the added problem of confounding by indication, a direct comparison of our results with other studies would be not appropriate.…”

Chemokine and Cytokine Profiles in Patients with Hand Osteoarthritis

“…All nine increased mediators of inflammation have been previously validated as key players in modulating the immune response of various rheumatic diseases, such as rheumatoid arthritis (RA), spondyloarthritis, and systemic lupus erythematosus [ 43 , 44 , 45 ]. Therefore, based on the role of inflammation in the pathogenesis of OA [ 10 ], our results support the contribution of inflammation to the development and progression of HOA.…”

Recent advances and prospects of axial spondyloarthritis / ankylosing spondylitis treatment

“…Следует отметить, что рентгенологическое прогрессирование АС при применении как иФНОα, так и иИЛ17А обычно сводилось к минимуму или стабилизировалось при длительной терапии (>2 лет), при этом существенных различий между препаратами двух групп практически не наблюдалось [105].…”