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Letter
Evidence in support of the validity of the TNF brake hypothesis
  1. Walter P Maksymowych
  1. Correspondence to Dr Walter P Maksymowych, Rheumatic Disease Unit, University of Alberta, Medicine, Edmonton, AB, Canada T6G2S2; walter.maksymowych{at}ualberta.ca

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I read with interest the findings of an observational cohort study in which patients with AS receiving infliximab (IFX) (n=22) were compared for radiographic progression over 8 years with a historical cohort (n=34) naive to antitumour necrosis factor α therapy (anti-TNF).1 After adjusting for baseline damage there was no difference between treatment groups over the 0–4-year time frame, but a significantly greater rate of progression was evident in the 4–8-year time frame in the historical cohort. The authors then conclude that since there was less bone formation in the IFX-treated group, these data argue against a major role for the TNF-brake hypothesis.

The basis for this concluding statement is that the authors interpret the TNF brake hypothesis as implying that the use …

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