Major reduction in spinal inflammation in patients with ankylosing spondylitis after treatment with infliximab: Results of a multicenter, randomized, double‐blind, placebo‐controlled magnetic resonance imaging study

Abstract

Objective. To determine whether the effects of anti-tumor necrosis factor ␣ (TNF␣) in reducing the signs and symptoms of ankylosing spondylitis (AS) coincide with a reduction in spinal inflammation as detected by magnetic resonance imaging (MRI).Methods. Pre-and postgadolinium T1 and STIR MR images of the spine were acquired at baseline and at week 24 in patients with AS who participated in a multicenter, randomized, double-blind, placebocontrolled study. Patients were randomly assigned at an 8:3 ratio to receive infusions of infliximab (5 mg/kg) or placebo at weeks 0, 2, and 6 and then every 6 weeks thereafter. MR images were obtained and evaluated independently by 2 readers who were blinded to the treatment allocation and time sequence of the images.Results. A total of 194 patients in the infliximab group and 72 patients in the placebo group had evaluable images at baseline and week 24. About 80% of the patients had at least 1 active spinal lesion at baseline, as assessed by MRI. The improvement in the MRI Activity Score after 6 months was significantly greater in the patients who received infliximab (mean 5.02, median 2.72) than in those who received placebo (mean 0.60, median 0.0) (P < 0.001). Almost complete resolution of spinal inflammation was seen in most patients who received infliximab, irrespective of baseline activity.Conclusion. Patients with AS who received infliximab therapy showed a decrease in spinal inflammation as detected by MRI, whereas those who received placebo showed persistent inflammatory spondylitis.

A 2-year comparative open label randomized study of efficacy and safety of etanercept and infliximab in patients with ankylosing spondylitis

“…Several clinical studies have shown that etanercept reduces disease activity in patients with spondyloarthropathies, including reactive arthritis and AS [4][5][6][7][8]. Similar results have been reported with inXiximab, a chimeric monoclonal antibody against TNF [9][10][11][12][13][14][15]. The aim of the present work was to compare the eYcacy and safety of both etanercept and inXiximab in patients with ankylosing spondylitis in a two-year open label randomised study.…”

Critical appraisal of assessment of structural damage in ankylosing spondylitis: Implications for treatment outcomes

“…Treatment of patients with active AS using the currently approved TNF-blocking agents, infliximab (1), etanercept (2), and adalimumab (3), has been shown to be strongly effective for the improvement of signs, symptoms, and function and for the reduction of C-reactive protein levels and active inflammation in the sacroiliac joints and spine, as shown by magnetic resonance imaging (MRI) (4). TNF blockers have also been shown to be effective for control of extraspinal rheumatic manifestations and, with some differences between the TNF blockers, for amelioration of further AS-associated manifestations such as uveitis, colitis, and psoriasis (5).…”

Focal fat lesions at vertebral corners on magnetic resonance imaging predict the development of new syndesmophytes in ankylosing spondylitis

“…The former are thought to evolve into Romanus lesions and the latter are thought to reflect spondylodiscitis. It has been shown that the severity of the MRI changes correlates with the histopathologic grading of inflammation (7), and reductions in active inflammatory lesions are readily visible on MRI within a few weeks following initiation of anti-TNF treatment (8)(9)(10).…”