Absence of Radiographic Progression at Two Years in a Cohort of Patients With Non-radiographic Axial Spondyloarthritis Treated With TNF-α Blockers

Almirall, Míriam; López-Velandia, Josue Guillermo; Maymó, Joan

doi:10.1016/j.reumae.2013.12.014

Cited by 4 publications

(3 citation statements)

References 9 publications

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“…Only a few studies investigated the effect of TNFi on SIJ of patients with axSpA. Almirall et al found no significant progress in the SIJ in a cohort of patients with nr-axSpA treated with TNF-α blockers for 2 years ( 44 ). Another study of the RAPID-axSpA phase III randomized trial found that patients with axSpA treated with TNFi did not show significant SIJ progression after 4 years ( 45 ).…”

Section: Discussionmentioning

confidence: 99%

Structural Lesion Progression of the Sacroiliac Joint and Clinical Features in axSpA During TNFi Reduction: A Retrospective Cohort Study

Dong

et al. 2021

Front. Med.

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Objective: In the clinic, some patients with axial spondyloarthritis (axSpA) have to reduce tumor necrosis factor inhibitor (TNFi) for various reasons. However, there are few studies about how to balance the relapse and TNFi reduction. Here we retrospectively analyzed the structural progression of the sacroiliac joint (SIJ) and clinical features in axSpA during TNFi reduction.Methods: A total of 108 patients with axSpA who followed up for 2 years and completed at least baseline, 12-month, and 24-month MRI scans of SIJ were divided into the tapering group (n = 63) and withdrawal group (n = 45) according to whether TNFi was stopped. We divided 2 years into five intervals, calculating the average dose quotient (DQ) for each of 540 intervals from 108 patients. By using generalized estimation equations with inverse probability of treatment weighting, we investigated the unbiased effects of average DQ on structural progression and treatment response.Results: The disease activity (such as Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Ankylosing Spondylitis Disease Activity Score (ASDAS)-CRP, and ASDAS-ESR) and relapse rate were lower in the tapering group at 12 and 24 months (p < 0.05). Δerosion (β = −0.0100, p = 0.00026) and Δthe Spondyloarthritis Research Consortium of Canada (SPARCC; β = −0.0959, p < 0.0001) were negatively correlated with average DQ. The average DQ 30 (74.8%, 80.0%) or 41.6 (76.5%, 83%) was best to discriminate the status of treatment response or the status of bone marrow edema, but considering operability, the average DQ 25 (78.0%, 63.3%) was also acceptable especially for patients with HLA-B27 negative and non-severe fat metaplasia.Conclusion: Complete TNFi withdrawal was not recommended. Our study provided a referable strategy (tapering then maintained the average DQ over 30 or even 25) for patients who need TNFi reduction. Higher dose usage of TNFi was associated with a slower erosion progression of SIJ.

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Section: Discussionmentioning

confidence: 99%

Structural Lesion Progression of the Sacroiliac Joint and Clinical Features in axSpA During TNFi Reduction: A Retrospective Cohort Study

Dong

et al. 2021

Front. Med.

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“…Only 1 study exploring the effects of TNFi on SI joint radiographic progression (from the Evaluation of Change in Structural Radiographic SI Joint Damage after 2 years of Etanercept Therapy [EMBARK] trial) was included in our study, which did not show any significant difference (41). A study by Almirall et al and the Certolizumab Pegol in Subjects with Active Axial SpA (RAPID-axSpA) study were not included in our meta-analysis, as all patients in these studies were treated with TNFi with no comparator arm (54,60). These studies showed no radiographic progression at the spine/SI joint at 2 years or at the SI joint at 4 years.…”

Section: Discussionmentioning

confidence: 99%

Effect of Therapy on Radiographic Progression in Axial Spondyloarthritis: A Systematic Review and Meta‐Analysis

Karmacharya

Duarte‐García

Dubreuil

et al. 2020

Arthritis & Rheumatology

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Objective. To investigate the effect of therapies on radiographic progression in patients with axial spondyloarthritis (SpA). Methods. A comprehensive database search for studies assessing radiographic progression in axial SpA (particular treatment versus no treatment of interest) was performed. Study-specific standardized mean differences in treatment outcomes at 2 and ≥4 years were estimated and combined using random-effects models.Results. Twenty-four studies in patients with axial SpA were identified, of which 18 involved tumor necrosis factor inhibitors (TNFi), 8 involved nonsteroidal antiinflammatory drugs (NSAIDs), and 1 involved secukinumab. Spinal radiographic progression, as measured by the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS), was not significantly different between TNFi-treated and biologics-naive patients at 2 years (mSASSS difference −0.73 [95% confidence interval (95% CI) −1.52, 0.12], I 2 = 28%) and ≥4 years (mSASSS difference −2.03 [95% CI −4.63, 0.72], I 2 = 63%). Sensitivity analyses restricted to studies with a low risk of bias showed a significant difference in spinal radiographic progression between TNFi-treated and biologics-naive patients at ≥4 years (mSASSS difference −2.17 [95% CI −4.19, −0.15]). No significant difference in spinal radiographic progression was observed between NSAID-treated and control patients (mSASSS difference −0.30 [95% CI −2.62, 1.31], I 2 = 71%) or between secukinumab-treated and biologics-naive patients (mSASSS difference −0.34 [95% CI −0.85, 0.17]). With regard to treatment differences in patients with nonradiographic axial SpA or in patients with radiographic progression measured using the sacroiliac joint score, an insufficient number of studies were available for analysis.Conclusion. Although no significant protective effect of TNFi treatment on spinal radiographic progression was seen over the course of 2 years or ≥4 years in patients with axial SpA, our analysis restricted to studies with a low risk of bias showed a protective effect of TNFi after ≥4 years. Therefore, long-term TNFi exposure might confer beneficial effects on spinal radiographic progression in axial SpA. No difference in radiographic progression at 2 years was seen in either the NSAID or secukinumab treatment groups compared to their controls. Future studies should explore the effects of biologic treatment on radiographic progression, as well as the effects of long-term biologics exposure, in patients with early axial SpA or those with nonradiographic axial SpA.

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“…Patients with a high chance of progressing to r-axSpA might require different treatment strategies in order to prevent this irreversible change; however, there is still no evidence that the drugs currently available to treat axSpA 3 (including NSAIDs, TNF blockers, and a recently approved IL-17 blocker) are actually capable of achieving this goal, and it is possible that this can only be achieved by drugs with different mechanisms of action: namely, drugs targeting bone metabolic pathways. 4 Previous studies have attempted to determine the percentage of patients who progress from nr-axSpA to r-axSpA over time 5,6 ; however, these studies had important methodological limitations and included a small number of patients. A third study, performed using the German Spondyloarthritis Inception Cohort (GESPIC), has provided the most relevant data so far.…”

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confidence: 99%

Sacroiliac joint radiographic progression — speed and determinants

Navarro-Compán¹,

Machado

2016

Nat Rev Rheumatol

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Non-radiographic axial spondyloarthritis (nr-axSpA) and radiographic axial spondyloarthritis (r-axSpA) are considered to represent different spectra of the same disease. Accumulating data suggest that the transition rate from nr-axSpA to r-axSpA in patients with early disease is low and identify inflammation, smoking and HLA-B27 positivity as factors associated with transition.Refers to: Dougados, M. et al. Rate and predisposing factors of sacroiliac radiographic progression after a 2 years follow-up period in recent onset spondyloarthritis. Arthritis Rheumatol.

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Absence of Radiographic Progression at Two Years in a Cohort of Patients With Non-radiographic Axial Spondyloarthritis Treated With TNF-α Blockers

Cited by 4 publications

References 9 publications

Structural Lesion Progression of the Sacroiliac Joint and Clinical Features in axSpA During TNFi Reduction: A Retrospective Cohort Study

Structural Lesion Progression of the Sacroiliac Joint and Clinical Features in axSpA During TNFi Reduction: A Retrospective Cohort Study

Effect of Therapy on Radiographic Progression in Axial Spondyloarthritis: A Systematic Review and Meta‐Analysis

Sacroiliac joint radiographic progression — speed and determinants

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