Long-term effects of Tumour Necrosis Factor Inhibitors on radiographic sacroiliitis progression in patients with axial spondyloarthritis

Background Cohort studies have demonstrated a minimal but noticeable increase in radiographic sacroiliitis, a function-limiting condition in patients with axial spondyloarthritis (axSpA). Recent studies suggest that early and prolonged use of tumor necrosis factor inhibitors (TNFi) may slow radiographic spinal progression in axSpA patients. However, it's not clear whether they have a similar effect on the progression of radiographic progression in the sacroiliac joints (SIJ). Therefore, this study focused on the long-term relationship between TNFi treatment and progression of radiographic sacroiliitis in axSpA patients. Methods A total of 301 patients from the German Spondyloarthritis Inception Cohort (GESPIC) were enrolled in this analysis. These participants were diagnosed as nonradiographic axSpA (nr-axSpA, symptom duration ≤5 years, 166 patients) or radiographic axSpA (r-axSpA, symptom duration ≤10 years, 135 patients), and were selected based on the availability of at least two sets of SIJ radiographs. Two calibrated expert readers evaluated the radiographs by using the modified New York criteria. The sacroiliac sum score, representing the mean of the two readers' scores, was used to measure sacroiliitis progression. The relationship between TNFi use (both past and present) and changes in the sacroiliitis sum score over two years were examined by using longitudinal generalized estimating equations (GEE) analysis. Results Included patients contributed with a total of 737 2-year radiographic intervals. At base-line, 9 (3.0%) patients had been treated with TNFi, and 87 (28.9%) were treated with TNFi at any time during the study. A total of 141 radiographic intervals were covered with TNFi treatment of any duration and 109 of those were covered treatment for at least 12 months. We found that patients who received TNFi for more than 12 months in the previous interval had less progression in the Sacroiliitis Sum Score than those who did not receive. However, a similar effect wasn't observed in patients who received TNFi during (either any duration or more than 12 months) in the current radiographic interval. The association between reduced progression and 12-month TNFi use in the previous interval was further confirmed by an adjusted multivariable longitudinal GEE analysis. In addition, similar trends suggesting a benefit of TNFi were observed in different models adjusting for different durations of TNFi treatment in the previous two-year interval. Conclusions TNFi treatment in axSpA patients appeared to slow the progression of radiographic sa-croiliitis, particularly between 2 and 4 years after treatment initiation. This finding highlights the potential of TNFi to modify the course of axSpA, particularly in its early stages.

Author dc:creator

• Torgutalp, Murat

• Tumor Necrosis Factor Inhibitors
• Radiographic Sacroiliitis Progression
• Axial Spondyloarthritis

Licence dc:rights.uri

• http://www.fu-berlin.de/sites/refubium/rechtliches/Nutzungsbedingungen

Language dc:language

eng

Identifier URI

http://dx.doi.org/10.17169/refubium-50660

OAI record oai:identifier

https://refubium.fu-berlin.de/oai/request?verb=GetRecord&metadataPrefix=dim&identifier=oai%3Arefubium.fu-berlin.de%3Afub188%2F50933