Objectives In patients with early axial spondyloarthritis (SpA) with a disease duration of less than 5 years and evidence of active inflammation on whole-body magnetic reonance imaging (MRI) in the spine and/or the sacroiliac joints (SI-joints) at baseline (BL) (1) we assessed the degree of fluctuation of active inflammation on MRI during treatment with etanercept (ETN).
Methods In the ESTHER trial axial SpA patients were treated with ETN (n= 40) versus sulfasalazine (n= 36) in the first year . After one year all patients who continued the study on active treatment were treated with ETN . For this analysis we primarily assessed those patients who were treated with ETN, had active inflammation in the spine and/or SI-joints at BL according to both scorers and of whom complete MRI sets were available from BL, W(eek) 48 and W108. These were 11 patients with evidence for spinal inflammation (253 vertebral units (VUs) assessed) and 25 patients for active sacroiliitis (200 SI-joint quadrants assessed). We also assessed the sites without inflammation at BL compared to W108: there were 15 ETN patients without spinal inflammation at BL (in total 345 VUs). And only 1 patient did not show active sacroiliitis on MRI at BL (in total 8 quadrants).
Results More than 70% of active inflammatory lesions in the spinal VUs and the SI-joint quadrants resolved between BL and W48 and between BL and W108 (table 1). New inflammatory lesions developed only in about 2.5% of VUs or SI-joint quadrants (table 1).
Similarly, when the SI-joint quadrants and spine VUs without inflammation at BL were analysed, at W108 less than 1% showed new inflammatory lesions: only in 0.9% (3 out of 345) [95% CI: 0.2- 2.5] of VUs new lesions developed. And in no SI-joint quadrant (0% [95% CI: 0-34.0%]) new lesions developed at W48 or W108.
Conclusions Nearly no new inflammatory lesions developed during 2 years of etanercept treatment in this early axial SpA cohort. Whether this also prevents the occurrence of bone proliferation has to be proven by longer follow-ups.
Song I-H. et al. Ann Rheum Dis. 2011 Apr; 70(4):590-596.
Song I-H et al. Ann Rheum Dis. 2012 Jul; 71(7):1212-1215
Disclosure of Interest I.-H. Song: None Declared, K.-G. Hermann: None Declared, H. Haibel Speakers bureau: Pfizer/Wyeth Pharmaceuticals, Merck Sharp Dohme/Schering Plough, Abbott Immunology Pharmaceuticals: consulting fees or other remuneration, C. Althoff: None Declared, D. Poddubnyy Speakers bureau: Pfizer/Wyeth Pharmaceuticals, Merck Sharp Dohme/Schering Plough, Abbott Immunology Pharmaceuticals: consulting fees or other remuneration, J. Listing: None Declared, A. Weiß: None Declared, E. Lange Employee of: employee from Pfizer, Germany, B. Freundlich Employee of: former employee from Pfizer, M. Rudwaleit Speakers bureau: Pfizer/Wy eth Pharmaceuticals, Merck Sharp Dohme/Schering Plough, Abbott Immunology Pharmaceuticals, UCB: consulting fees or other remuneration, J. Sieper Grant/research support from: research grant from Pfizer/Wyeth, Abott, Speakers bureau: Pfizer/Wy eth Pharmaceuticals, Merck Sharp Dohme/Schering Plough, Abbott Immunology Pharmaceuticals, UCB: consulting fees or other remuneration