Impact of Tumor Necrosis Factor Inhibitor Versus Nonsteroidal Antiinflammatory Drug Treatment on Radiographic Progression in Early Ankylosing Spondylitis: Its Relationship to Inflammation Control During Treatment

Abstract

Objective. To investigate the impact of tumor necrosis factor inhibitor (TNFi) treatment and inflammation control on radiographic progression in early ankylosing spondylitis (AS) over 4 years.Methods. We included a total of 215 patients with early AS (symptom duration <10 years) treated with TNFi (the TNFi group; n = 135) or with nonsteroidal antiinflammatory drugs (NSAIDs) (the control group; n = 80). Two blinded readers assessed radiographic progression using the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). Inflammation control was inferred from C-reactive protein (CRP) levels time-averaged between 2 radiologic assessments. Linear mixed modeling was used to estimate mSASSS changes over radiographic intervals as well as the impact of clinical factors on outcomes.Results. The TNFi group had longer disease duration, a higher baseline CRP level, and a higher Bath Ankylosing Spondylitis Disease Activity Index than did controls. The time-averaged CRP level over radiographic intervals was lower with TNFi treatment than with NSAID treatment (mean ± SD 0.27 ± 0.30 mg/dl versus 0.61 ± 0.68 mg/dl; P < 0.001). Overall, mean ± SD mSASSS change over the 2-year interval was 1.30 ± 2.97 units. In the multivariable model adjusted for age, smoking status, baseline CRP level, and the presence of syndesmophytes at baseline, the TNFi group showed less mSASSS change over the 2-year interval (β = −0.90 [95% confidence interval {95% CI} −1.51, −0.29]). However, when a time-averaged CRP level was additionally included, it significantly influenced the mSASSS change (β = 1.02 [95% CI 0.32, 1.71]), decreasing the estimated group difference (β = −0.52 [95% CI −1.17, 0.14]). NSAID indices of both groups were not associated with either time-averaged CRP levels or mSASSS changes.Conclusion. Effective suppression of inflammation by TNFi treatment decreases radiographic progression in early AS.

Tumour necrosis factor inhibitors slow radiographic progression in patients with ankylosing spondylitis: 18-year real-world evidence

“…In a recent study, Park et al showed that early TNFi treatment can reduce radiographic progression by inflammation control. 15 They enrolled a TNFi treatment group from one single-centre cohort and a conventional NSAID treatment group from another single cohort to analyse the effect of TNFi on radiographic progression. However, as mentioned in their limitation, they also have a problem with 'confounding by indication', as patients had significantly different baseline characteristics between periods exposed and not exposed to TNFi.…”

“…3 5 14 15 A high inflammation level at TNFi initiation and long-term TNFi use appear to reduce radiographic progression in a longitudinal cohort study. [14][15][16][17] Real-world evidence refers to clinical evidence obtained from the analysis of real-world data to determine drug effects. 18 We expected that with respect to chronic diseases, a study investigating the relationship between drug effects and ankylosis using various healthcare data accumulated over a long period of time, mainly from electronic medical records (EMRs), will provide real-world evidence from patients with AS.…”

Association of Uveitis with Radiographic Progression in Patients with Axial Spondyloarthritis: A Propensity Score Matching Analysis

“…Smoking and CRP level was not captured as having a significant association with radiographic progression in our study, and it depends partly on the multivariable models, design of studies and/or cohorts [23,33]. Influence of smoking on radiographic progression was further determined by its dose and the interaction with baseline syndesmophyte(s) and inflammation [23,34].…”

“…Influence of smoking on radiographic progression was further determined by its dose and the interaction with baseline syndesmophyte(s) and inflammation [23,34]. Use of TNF inhibitors can effectively suppress the inflammation, leading to the decrease in the radiographic progression regardless of baseline CRP level [33,35]. In this study, over a half of the patients (n=101, 57.4%) received TNF inhibitors and use of TNF inhibitors was marginally associated with the slowed progression (OR [95% CI] 0.39 [0.15, 1.01], p=0.052; Table 2).…”

Inflammatory events in patients with sagittal imbalance through platelet-associated inflammation

“…All these events caused by inflammatory conditions have been the major reasons of back pain affecting people (19). Recent studies have pointed out that increased inflammatory conditions strongly affect the efficacy of surgical intervention in the affected spinal areas and the recovery period after surgery (21). Evaluation of the inflammatory condition may allow important predictions of the effectiveness of the surgical procedure and postoperative recovery (28).…”