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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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