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

Abstract

ObjectivesTumour necrosis factor inhibitors (TNFis) have been suggested to slow radiographic progression in patients with ankylosing spondylitis. However, limitations such as variations in disease activity, complex drug administration and short follow-up duration make it difficult to determine the effect of TNFis on radiographic progression. The aim of the study was to investigate whether long-term treatment with TNFis can reduce radiographic progression in patients with ankylosing spondylitis using 18-year longitudinal real-world data.MethodsThis retrospective study was conducted between January 2001 and December 2018 at a single centre. Among the 1280 patients whose electronic medical records were reviewed, data of 595 patients exposed to TNFis at least once were included. Among them, time intervals of TNFi exposure or non-exposure were determined in 338 patients (‘on the TNFis’ or ‘off the TNFis’ intervals, respectively). The difference in the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) change rate between ‘on the TNFis’ and ‘off the TNFis’ intervals was investigated.ResultsWe obtained 2364 intervals of 338 patients (1281 ‘on the TNFis’ and 1083 ‘off the TNFis’ intervals). In the marginal structural model for inverse probability of treatment weighting, the change rate of mSASSS significantly decreased with the use of TNFis (β=−0.112, p=0.004), and the adjusted mSASSS changes were 0.848 and 0.960 per year during ‘on the TNFis’ and ‘off the TNFis’ intervals, respectively.ConclusionCompared with treatment without TNFis, treatment with TNFis slowed radiologic progression significantly.

Tumor Necrosis Factor Inhibitors Reduce Spinal Radiographic Progression in Patients With Radiographic Axial Spondyloarthritis: A Longitudinal Analysis From the Alberta Prospective Cohort

“…With PS adjustment, we aimed to handle the absence of random treatment allocation and as such mitigate, to the extent possible, the possible effect of confounding by indication. A similar approach was used in a recent study that led to similar conclusions (39). Variables that precede, and influence, the decision to prescribe a TNFi and that also associate with radiographic progression were included and balanced among patients who were treated and those who were not treated at baseline.…”

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

“…36 This inflammation-suppression-mediated effect has been confirmed in recent studies. 11,37,38 However, the anti-inflammatory effect of cDMARDs has been shown to be weaker than that of TNF inhibitors in a randomized controlled study, 39 and improvement of sacroiliac joint and spine inflammation according to MRI scores in patients with early axial SpA was significantly less in the SSZ-treated group than the etanercept-treated group. 40,41 The inadequate efficacy of cDMARDs to suppress inflammation in the axial skeleton, despite previous reports of easing inflammatory back pain, 5 would not in turn lead to an inhibitory effect on structural damage progression.…”

“…Previously, we demonstrated TNF inhibitor effectiveness for slowing radiographic progression using time intervals during treatment. 11 However, it was difficult to evaluate the effect of cDMARDs on radiographic progression because the study design was focused on TNF inhibitors. Therefore, we investigated the effectiveness of cDMARDs on spinal radiographic progression from real-world longitudinal data based on a different design than previously used.…”

TNF-Inhibitoren verlangsamen die radiologische Progression bei Patienten mit ankylosierender Spondylitis

“…In einer retrospektiven Studie, die im Zeitraum 2001–2018 in einem einzigen Zentrum in Seoul, Republik Korea, durchgeführt wurde, untersuchten Forscher anhand der elektronischen Krankenakten, ob eine Langzeitbehandlung mit TNFi die radiologische Progression bei Patienten mit AS verringern kann [6]. Bei jedem Patienten wurden Intervalle «unter TNFi» und «ohne TNFi» definiert (siehe Abbildungs 1).…”