Sacroiliac joint radiographic progression in axial spondyloarthritis is retarded by the therapeutic use of TNF inhibitors: 12-year data from the SCQM registry

Abstract

ObjectivesTo analyse the effect of tumour necrosis factor inhibitors (TNFi) on sacroiliac joint (SIJ) radiographic progression in axial spondyloarthritis (axSpA).MethodsPatients with axSpA in the Swiss Clinical Quality Management cohort with up to 12 years of follow-up and radiographic assessments every 2 years were included. SIJs were scored by two readers according to the modified New York criteria blinded to chronology. The relationship between TNFi use before or during a 2-year radiographic interval and SIJ progression was investigated using generalised estimating equation models with adjustment for potential confounding. Progression was defined as worsening of ≥1 grade in ≥1 SIJ and ignoring a change from 0 to 1 over 2 years, if both readers agreed. A third reading of radiographs was integrated in sensitivity analyses.ResultsA total of 515 patients with axSpA contributed to data for 894 radiographic intervals (24 progression events). In patients with complete covariate data, prior use of TNFi reduced the odds of progression (OR 0.21, 95% CI 0.07 to 0.65). A comparable effect was found for use of TNFi for ≥1 year within a 2-year radiographic interval (OR 0.21, 95% CI 0.08 to 0.55). The inhibitory impact of TNFi was confirmed if progression was demonstrated in 2/3 readings: OR 0.50, 95% CI 0.28 to 0.89 and OR 0.46, 95% CI 0.27 to 0.78 for TNFi treatment before and for ≥1 year within the interval, respectively.ConclusionTNFi are associated with deceleration of SIJ radiographic progression in patients with axSpA if treatment is continued for ≥1 year.

Upadacitinib in real clinical practice: new horizons in the treatment of axial spondyloarthritis

“…The relative proportion of patients with BASDAI < 4 is 90.4%, an impressive result. Meanwhile, this outcome is better than the known data from SELECT AXIS 1 [17]. A possible explanation for this difference might be that over half of the patients in the present study have prior experience with biologic drugs.…”

“…The inference that can be drawn is that the administration of the primary preceding biologic medication (TNFi) might be associated with a lower likelihood of AH. Such an association has already been identified, and there are available findings indicating reduced cardiovascular risks in TNFi treatments [16,17].…”

Significance of structural changes in the axial skeleton in patients with axial spondyloarthritis: how important are lesions in the sacroiliac joint?

“…However, a reduction of erosions and ankylosis in the SIJ as assessed by MRI during bDMARD and tsDMARD treatment has recently also been reported in axSpA patients. [9][10][11][12] While studies looking at radiographic changes in the SIJ in early disease have already been published a while ago 13 14 there is now a new report on such changes 15 from the Swiss cohort which is well known because the authors have already provided more retrospective evidence that TNFi have decelerating effects on radiographic spinal progression in axSpA which is related to a decrease of inflammation as suggested by reduction of C reactive protein (CRP) levels. 16 Indeed, the situation is quite complex.…”

Sacroiliac radiographic progression over 10 years in axSpA: data from the DESIR inception cohort

“…A more recent analysis of the Swiss Quality Management cohort used one of our proposed definitions to assess radiographic progression at the SIJ level, that is, a worsening in at least one grade of mNY in at least one SIJ, and found an overall 4.5% proportion of progressors per 2-year period22; but more interestingly, they also found a ‘protective’ effect of TNFi exposure during the radiographic interval (2 years) (OR 0.21, 95% CI 0.07 to 0.65). The magnitude of the protective effect in their study seems much larger than our findings, but this may be due to the different analysis of the exposure, which was time-varying in our case but only using the information available at the study visits versus a rather quantitative approach in their analysis, suggesting a trend for an additive inhibitory effect for each additional year of TNFi treatment.…”