Effects of etanercept versus sulfasalazine in early axial spondyloarthritis on active inflammatory lesions as detected by whole-body MRI (ESTHER): a 48-week randomised controlled trial

Abstract

PurposeTo evaluate the potential of etanercept versus sulfasalazine to reduce active inflammatory lesions on whole-body MRI in active axial spondyloarthritis with a symptom duration of less than 5 years.MethodsPatients were randomly assigned to etanercept (n=40) or sulfasalazine (n=36) treatment over 48 weeks. All patients showed active inflammatory lesions (bone marrow oedema) on MRI in either the sacroiliac joints or the spine. MRI was performed at weeks 0, 24 and 48 and was scored for active inflammatory lesions in sacroiliac joints and the spine including posterior segments and peripheral enthesitis by two radiologists, blinded for treatment arm and MRI time point.ResultsIn the etanercept group, the reduction of the sacroiliac joint score from 7.7 at baseline to 2.0 at week 48 was significantly (p=0.02) larger compared with the sulfasalazine group from 5.4 at baseline to 3.5 at week 48. A similar difference in the reduction of inflammation was found in the spine from 2.2 to 1.0 in the etanercept group versus from 1.4 to 1.3 in the sulfasalazine group between baseline and week 48, respectively (p=0.01). The number of enthesitic sites also improved significantly from 26 to 11 in the etanercept group versus 24 to 26 in the sulfasalazine group (p=0.04 for difference). 50% of patients reached clinical remission in the etanercept group versus 19% in the sulfasalazine group at week 48.ConclusionIn patients with early axial spondyloarthritis active inflammatory lesions detected by whole-body MRI improved significantly more in etanercept versus sulfasalazine-treated patients. This effect correlated with a good clinical response in the etanercept group.

Symptomatic Efficacy of Etanercept and Its Effects on Objective Signs of Inflammation in Early Nonradiographic Axial Spondyloarthritis: A Multicenter, Randomized, Double‐Blind, Placebo‐Controlled Trial

“…Recently, several studies of anti-TNF therapy have been conducted in nonradiographic axial SpA, with results suggesting that these agents have efficacy similar to that seen in radiographic axial SpA (15)(16)(17)(18)(19)(20). However, to date the number of large well-controlled studies of treatment with anti-TNF or other biologic agents in nonradiographic axial SpA, including populations of patients satisfying current ASAS criteria for nonradiographic axial SpA, is limited.…”

Magnetic Resonance Imaging of Sacroiliitis in Patients with Spondyloarthritis: Correlation with Anatomy and Histology

“…The anterior sacroiliac ligament (black arrows) gradually blends with the periosteum of the ilium and is therefore considered an enthesis (discontinuity due to cutting artifact). rigorous therapeutic regimen [11]. The positive likelihood ratio of MRI of the sacroiliac joints (SIJs) is as high as that of the HLA-B27 blood test [6].…”

Seronegative Spondyloarthropathies: Evolving Concepts Regarding Diagnosis and Treatment

“…However, pre-radiographic axial SpA patients had lower levels of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) and were better concerning function and metrology [29]. Further, clinical trials have shown that early axial SpA patients derive significant clinical benefits from TNFα blockade, which are associated with regression of spinal inflammation on MRI [30][31][32]. These observations have been incorporated in the 2010 updated ASAS recommendations for the use of anti-TNFα agents in SpA.…”