FRI0417 Long term influence of nsaids on radiographic progression in patients with ankylosing spondylitis.

Abstract

Background The inhibitory effect of the treatment on styructural damage in AS is not completely understood and it is sill a matter under debate. Recent data indicated that NSAIDs could retard radiographic progression in certain subgroups of patients[1],[2] Objectives To investigate the long term influence of NSAIDs on the rate of radiographic progression administrated as continuous vs.on-demand therapy. Methods Patients included in REGISPONSER with the diagnosis of AS were selected and ought to be administrated only NSAIDs for a period of 3 years. Patients were divided in 2 groups according to NSAIDs intake (continuously vs on-demand). BASRI-spine was applied at baseline and after 3 years. Patients who had the maximum BASRI value of 12 at baseline were excluded form the study. X2 test, student T test and ANCOVA were applied to compare differences between groups. A logistic regression was performed to analyze the influence of NSAIDs treatment and other factors on the rate of radiographic progression. Results One hundred eighteen patients were included. No significant differences were found in the two treatment groups at baseline, with exception of disease activity(table 1). Significant radiographic progression was identified in the 2 treatment groups after 3 years follow up( p<0.001). The mean BASRI change was 0.66 ± 1.04 in on-demand treatment group vs.0.64 ± 1.22 in continuous treatment group (p-NS after adjustment for symptoms duration). Although in the logistic regression the type of NSAID treatment was not identified as independent predictive factor of increased radiographic damage as were male sex (p= 0.025) and baseline damage (p<0.001), a significant interaction was found between NSAIDs treatment and time-average (ta) CRP (>6 vs. ≤6 mg/L) (OR: 0.04, CI95 %( 0.003-0.524) Conclusions NSAIDs treatment could not stop radiographic damage in AS. Patients with high CRP level who received NSAIDs on–demand showed the highest progression risk. References Poddubnyy D, Rudwaleit M, Haibel H, Listing J, Märker-Hermann E, Zeidler H, et al. Effect of non-steroidal anti-inflammatory drugs on radiographic spinal progression in patients with axial spondyloarthritis: results from the German Spondyloarthritis Inception Cohort. Ann Rheum Dis. 2012, 71:1616-22. Kroon F, Landewé R, Dougados M, van der Heijde D. Continuous NSAID use reverts the effects of inflammation on radiographic progression in patients with ankylosing spondylitis. Ann Rheum Dis. 2012;71:1623-9. Disclosure of Interest None Declared

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

“…Among the 8 NSAID studies, 6 studies included only patients with AS (25,34,36,37,49,50), 1 study evaluated patients with early axial SpA (39), and 1 study included both patients with AS and patients with nonra diographic axial SpA (48). Six studies used scores based on the mSASSS (26,34,36,37,39,48), 1 study used BASRI spine scores (49), and 1 study used the baseline SI joint score (25).…”

“…Subgroup analyses using these comparisons (continuous versus on-demand NSAIDs, NSAID index high versus low, and NSAID use versus no NSAID use) showed no differences (each P = 0.79). There was one study in which the BASRI spine score was compared between the NSAID and control groups, and no difference was found (BASRI spine score difference 0.020 [95% CI −0.44, 0.48]) (49). One study showed NSAID effects in a subgroup of patients with nonradiographic axial SpA, in whom no difference in mSASSS scores was observed between the NSAID-treated patients and controls (mSASSS difference 0.13 [95% CI −0.39, 0.65]) (48).…”

Non-steroidal Anti-inflammatory Drugs Are Unlikely to Inhibit Radiographic Progression of Ankylosing Spondylitis: A Systematic Review

“…A total of 221 articles were retrieved, 18 of them were duplicates, and 195 failed to meet the inclusion criteria. Two meeting abstracts lacking full texts (12, 13) and one paper reporting protocols comparing the effects of treatment with NSAIDs combined with TNFi vs. TNFi alone on spinal radiographic progression over a period of 2 years (15) were further excluded. Finally, 5 full-text papers (7–11) were included in this systemic review (Figure 1).…”

“…Our literature review identified that most of the studies challenge the earlier concept that NSAIDs delay radiographic progression in AS. In two meeting abstracts, Schiotis et al (13) reported both the two treatment groups for AS showed significant radiographic progression over 3 years ( P < 0.001), while continuous NSAIDs ( n = 81) did not inhibit radiographic progression; and Haroon et al (12) reported there was no significant difference between the changes in mSASSS over 2 years compared continuous NSAIDs in combination with TNFi and TNFi alone in 40 AS patients. Multivariable analysis of data from both OASIS and Swiss cohorts of patients, with ≥10 years follow-up, revealed that NSAID use was not an independent factor related to radiographic progression (21, 23).…”

“…Non-steroidal anti-inflammatory drugs (NSAIDs) are recommended as the initial drug treatment for AS patients by several academic organizations including the Assessment of SpondyloArthritis International Society (ASAS)/European League Against Rheumatism (EULAR) and American College of Rheumatology (ACR)/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network (SPARTAN) (4, 5), mainly because both non-selective cyclooxygenase (COX) inhibitors and selective COX-2 antagonists are effective in relieving symptoms in patients with AS that is active (6). There is some conflicting evidence as to whether or not long-term treatment with NSAIDs delays the development of damage to the spine (7–13). The aims of this review were to analyze the background, methodology employed and findings of published studies to determine whether NSAIDs possess disease-modifying properties in patients with AS.…”