Ankylosing spondylitis disease activity score is related to NSAID use, especially in patients treated with TNF-α inhibitors

Abstract

BackgroundNon-steroidal anti-inflammatory drugs (NSAIDs) are regarded as the cornerstone of conventional treatment for AS. However little is known about concomitant NSAID use during treatment (with TNF-α inhibitors) in daily clinical practice.Methods and findingsConsecutive patients from the GLAS cohort were included. NSAID use and ASAS-NSAID index were evaluated at group level and at individual patient level during 52 weeks of follow-up. Analyses were stratified for treatment regimen. Generalized estimating equations (GEE) was used to evaluate NSAID use in relation to assessments of disease activity over time. In patients starting TNF-α inhibitors (n = 254), 79% used NSAIDs at baseline and this proportion decreased significantly to 38% at 52 weeks. ASAS-NSAID index also decreased significantly from median 65 to 0. In patients on conventional treatment (n = 139), 74% used NSAIDs at baseline with median ASAS-NSAID index of 50 and this remained stable during follow-up. At each follow-up visit, approximately half of the patients changed their type or dose of NSAIDs. GEE analysis over time showed that NSAID use was associated with AS disease activity score (p<0.05). This relation was more pronounced in patients treated with TNF-α inhibitors compared to conventional treatment (B = 0.825 vs. B = 0.250).ConclusionsIn this observational cohort of established AS patients, there was no difference in baseline NSAID use between patients with and without indication for TNF-α inhibitors. NSAID use decreased significantly after starting TNF-α inhibitors. During conventional treatment, NSAID use remained stable at group level. However, NSAID use changed frequently at individual patient level and was significantly associated with disease activity.

Non-steroidal anti-inflammatory drug use is determined by disease activity in axSpA and decreased by biologicals: a longitudinal analysis

“…Nevertheless, in contrast to our ndings, the authors also reported that baseline NSAID use was similar in the TNFi and conventional treatment groups (79% vs 74%; p=0.131) (17). The reason for the high NSAID use in both treatment groups was not clear in this study because baseline disease activity was higher in the patients who were put on TNFi treatment (17).…”

“…It was also shown in an observational study that treatment with tumor necrosis factor inhibitor (TNFi) was associated with a decrease in the proportion as well as the dosage of the NSAIDs in patients with axSpA in a real-life setting (16). Recently, another observational study revealed that longitudinal NSAID use was associated with disease activity, particularly in patients treated with TNFi (17).…”

Brazilian recommendations for the use of nonsteroidal anti-inflammatory drugs in patients with axial spondyloarthritis

“…After 12 months of follow-up, both groups had similar activity scores (BASDAI=3.4 and ASDAS=2.2 vs. BASDAI=3.7 and ASDAS=2.3, respectively). Among patients who received conventional treatment, 82% maintained a sustained response with NSAIDs after 52 weeks [55]. Despite being observational studies whose primary objective was not to evaluate the response to treatment, the high rate of drug retention observed over time suggested a sustained efficacy of NSAIDs.…”

Ondansetron enhanced diclofenac‐induced nephrotoxicity in mice

“…DIC with several anti‐inflammatory, antipyretic, and analgesic properties is widely being used for the treatment of inflammatory disease like rheumatoid arthritis, spondylitis ankylosing, and post‐operative and post‐chemoradiotherapy inflammations. Unfortunately, besides the therapeutic benefits of DIC administration, its chronic uses induced nephrotoxicity and renal failure .…”