TY - JOUR
T1 - Long-term effect of TNF inhibitors on radiographic progression in ankylosing spondylitis is associated with time-averaged CRP levels
AU - Konsta, Maria
AU - Sakellariou, Grigorios T.
AU - Rusman, Tamara
AU - Sfikakis, Petros P.
AU - Iliopoulos, Alexios
AU - van der Horst-Bruinsma, Irene E.
N1 - Funding Information: IvdH: has received consulting fees, research or institutional support and educational grants from: AbbVie, Eli-Lilly, Bristol Myers-Squibb, MSD, Novartis, Pfizer and UCB Pharma. All the other authors declare that they have no competing interest. Publisher Copyright: © 2020 Société française de rhumatologie Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/5/1
Y1 - 2021/5/1
N2 - Objective: To investigate whether the impact of long-term treatment (> 3 years) with TNF inhibitors (TNFi) on radiographic progression in AS is associated with the level of acute phase reactants during therapy. Methods: One hundred and one consecutive AS patients under TNFi [65 men; age: 41.6 ± 11 years (mean ± SD), with symptom duration: 17 ± 10 years] were included in this retrospective study. Lateral X-rays of cervical and lumbar spine, obtained before TNFi initiation, were compared to those obtained after a period of 7 ± 2.5 (range: 3–15) years. The levels of CRP and ESR were evaluated every 6 months. The modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) assessed the radiographic damage. New syndesmophyte formation or ΔmSASSS-score/year ≥ 1 unit/year was defined as radiographic progression. Results: Forty-seven patients (46.5%) showed radiographic progression. ΔmSASS-score/year was positively correlated with both, baseline CRP (r = 0.35, P < 0.001) and ESR (r = 0.3, P < 0.01), as well as with time-averaged CRP (r = 0.3, P < 0.01). Furthermore, ΔmSASS-score/year was significantly higher (P < 0.0001) in patients with syndesmophytes at baseline [0.9 (0.4–1.8), median (IQR)] compared to those without [0 (0–0.4)]. In the multivariate logistic regression analysis, independent risk factors for spinal radiographic progression during TNFi treatment were the presence of syndesmophytes at baseline (OR: 14.7, 95%CI:4.9–44) and the time-averaged CRP > 5 mg/L (OR:7.6, 95%CI: 2.5–23). No gender differences were observed. Conclusion: In AS patients with long standing disease, radiographic progression during TNFi treatment is significantly associated with higher levels of time-averaged CRP.
AB - Objective: To investigate whether the impact of long-term treatment (> 3 years) with TNF inhibitors (TNFi) on radiographic progression in AS is associated with the level of acute phase reactants during therapy. Methods: One hundred and one consecutive AS patients under TNFi [65 men; age: 41.6 ± 11 years (mean ± SD), with symptom duration: 17 ± 10 years] were included in this retrospective study. Lateral X-rays of cervical and lumbar spine, obtained before TNFi initiation, were compared to those obtained after a period of 7 ± 2.5 (range: 3–15) years. The levels of CRP and ESR were evaluated every 6 months. The modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) assessed the radiographic damage. New syndesmophyte formation or ΔmSASSS-score/year ≥ 1 unit/year was defined as radiographic progression. Results: Forty-seven patients (46.5%) showed radiographic progression. ΔmSASS-score/year was positively correlated with both, baseline CRP (r = 0.35, P < 0.001) and ESR (r = 0.3, P < 0.01), as well as with time-averaged CRP (r = 0.3, P < 0.01). Furthermore, ΔmSASS-score/year was significantly higher (P < 0.0001) in patients with syndesmophytes at baseline [0.9 (0.4–1.8), median (IQR)] compared to those without [0 (0–0.4)]. In the multivariate logistic regression analysis, independent risk factors for spinal radiographic progression during TNFi treatment were the presence of syndesmophytes at baseline (OR: 14.7, 95%CI:4.9–44) and the time-averaged CRP > 5 mg/L (OR:7.6, 95%CI: 2.5–23). No gender differences were observed. Conclusion: In AS patients with long standing disease, radiographic progression during TNFi treatment is significantly associated with higher levels of time-averaged CRP.
KW - Ankylosing Spondylitis
KW - Baseline syndesmophytes
KW - Radiographic progression
KW - Time-averaged CRP
UR - http://www.scopus.com/inward/record.url?scp=85099371026&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.jbspin.2020.105111
DO - https://doi.org/10.1016/j.jbspin.2020.105111
M3 - Article
C2 - 33278588
SN - 1297-319X
VL - 88
JO - Joint Bone Spine
JF - Joint Bone Spine
IS - 3
M1 - 105111
ER -