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THU0261 Continuous nsaid use reverts the effects of inflammation on radiographic progression in patients with ankylosing spondylitis
  1. F. Kroon1,
  2. R. Landewé2,
  3. M. Dougados3,
  4. D. van der Heijde1
  1. 1Rheumatology, LUMC, Leiden
  2. 2Rheumatology, AMC, Amsterdam, Netherlands
  3. 3Rheumatology, Cochin Hospital, Paris, France


Background In a recent clinical trial it was shown that continued treatment with nonsteroidal anti-inflammatory drugs (NSAIDs), in comparison to on-demand use of NSAIDs, reduced radiological progression in the spine in patients with ankylosing spondylitis.(1) To improve the benefit-risk ratio it is crucial to understand which patients may have most to gain from continuous NSAID-use in terms of radiological progression.

Objectives The aim of this study was to compare continuous NSAID treatment and on-demand NSAID treatment with respect to their ability to suppress radiographic progression in subgroups of patients with elevated CRP-levels, elevated ESR, high ASDAS-levels or high BASDAI-levels in comparison to patients with normal levels.

Methods Post-hoc analyses were performed in the above referenced RCT. Relevant subgroups were created by splitting the groups at predefined values considered as high/elevated based on time-averaged (ta) CRP (>5mg/L), ta-ESR (>12mm/hr), ta-BASDAI (>4), ta-ASDAS-CRP (>2.1) and ta-ASDAS-ESR (>2.1). Subgroups were further split according to NSAID-use (continuous vs. on-demand). Statistical interactions were tested using multiple regression analysis. Differences in radiological progression between groups were analysed using the Chi-square and Mann-Whitney U test.

Results 150 randomized patients (continuous-treatment group (n=76), on-demand group (n=74)) had complete radiographs and were included in the analyses. The effect of slowing radiological progression, both as continuous dmSASSS or % patients progressing ≥2 mSASSS, with continuous NSAID therapy was more pronounced in patients with elevated ta-CRP-levels, elevated ta-ESR, high ta-ASDAS-CRP or high ta-ASDAS-ESR versus patients with low/normal values (p<0.05) (Table). No such effect was found for patients with high vs. low BASDAI. In patients with elevated ta-ESR (irrespective of treatment), structural progression was higher than in patients with normal ta-ESR (p<0.01). Regression analyses showed that continuous NSAID treatment neutralizes the deleterious effects of inflammation (high ta-ESR) (no statistical interaction).

Table 1

Conclusions Patients with elevated acute phase reactants benefit most from continuous NSAID treatment. Prioritizing patients with elevated acute phase reactants for continuous NSAID-treatment may improve the benefit-risk-ratio,of NSAID-treatment in AS.

  1. Wanders A et al. Arthritis Rheum. 2005;52:1756-65

Disclosure of Interest None Declared

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