Different effects of anti-TNF-alpha biologic drugs on the small bowel macroscopic inflammation in patients with ankylosing spondylitis

Abstract

Background & Aims. Considering the ability of anti-TNF alpha drugs to lower the burden intestinal inflammation in patients with inflammatory bowel disease (IBD), and the similarity between IBD and ankylosing spondylitis (AS) regarding inflammatory intestinal involvement, we aimed to investigate the impact of anti-TNF alpha biologic therapy on subclinical intestinal inflammation in AS patients.Methods. Between January 2008 and December 2013, 38 AS patients and 23 controls were enrolled in the study and investigated with small bowel videocapsule endoscopy examination and ileocolonoscopy. Each tertile of the small bowel (proximal, mid and distal) was assessed by calculating the Lewis score based on the image stream.Results. The Lewis scores were significantly higher in the AS group compared to controls (580.9 ± 818 vs. 81 ± 121, p<0.001). 16 patients (42.1%) were on anti-TNF alpha therapy (Adalimumab (n = 5), Infliximab (n = 5) or Etanercept (n = 6)).31.3% of them used NSAIDs simultaneously, compared with 77.3% of the other patients (p<0.01). Their Lewis scores were lower compared to the other patients for the entire small bowel (306 ± 164 vs. 790 ± 1038, p = 0.015), its proximal and distal tertiles (238 ± 154 vs. 560 ± 543, p = 0.021, and 140 ± 189 vs. 300 ± 220, p = 0.027, respectively). The Lewis score was also lower in patients receiving Adalimumab/ Infliximab compared to those on Etanercept for the entire bowel and its distal tertile (262 ± 165 vs. 380 ± 148, p = 0.069 and 62 ± 101 vs. 273 ± 236, p = 0.060, respectively).Conclusion. Anti-TNF alpha therapy in patients with AS reduces the subclinical intestinal inflammation, but the magnitude seems to depend upon the class anti-TNF alpha agent used (Clinical Trials. gov NCT00768950).

Inflammatory Bowel Diseases and Coexisting Spondyloarthritis: A Neglected and too Often Under-Reported Association by Radiologists. A Multicenter Study by Italian Research Group of Imaging in Rheumatology

“…The introduction of biological drugs (like TNFα inhibitor drugs) capable of changing the course of the disease if administered in the early-mid stages has emphasized the need to detect SI in patients with IBD, many of whom can be asymptomatic or show a normal SIJ radiograph [20][21][22]. Furthermore, when IBD and SpA coexist, the therapeutic strategy should be modulated to take into account the variable manifestations of IBD, in terms of intestinal and extra-intestinal features, and the clinical manifestations of SpA, with particular attention to peripheral enthesitis, dactylitis and anterior uveitis [7,[23][24][25]. Many patients with IBD undergo computed tomography enterography (CTE) and/or magnetic resonance enterography (MRE) as a part of their clinical care to evaluate the extent and severity of the disease and the response to treatment or due to suspicion of complications [26][27][28][29][30][31][32][33][34][35].…”

Application of nSMOL coupled with LC‐MS bioanalysis for monitoring the Fc‐fusion biopharmaceuticals Etanercept and Abatacept in human serum

“…Recent studies focusing on TNFα signaling have indicated that endogenous TNFα is a key mediator in specific inflammatory responses . The neutralizing TNF antagonists or monoclonal antibodies to TNF have exhibited clinically effective outcomes for many immune‐mediated inflammatory diseases (IMIDs) such as rheumatoid arthritis (RA), inflammatory bowel disease (IBD), psoriatic arthritis (PsA), vasculitis, ankylosing spondylitis (AS), and juvenile chronic arthritis (JCA) . Infliximab, Adalimumab, and Etanercept have been shown to have good therapeutic outcomes in various clinical trials since the first biopharmaceutical agents for IMID were launched in 1998 .…”