Article Text
Abstract
Objective The objective of the current study was to analyse the association between treatment with tumour necrosis factor inhibitors (TNFi) and radiographic spinal progression in patients with axial spondyloarthritis (axSpA) from a long-term inception cohort.
Methods A total of 243 patients with axSpA from the German Spondyloarthritis Inception Cohort with at least two sets of spinal radiographs obtained at least 2 years apart during a 10-year follow-up were included. Spinal radiographs were evaluated by three trained and calibrated readers according to the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). The association between the current TNFi, previous TNFi and radiographic spinal progression defined as the absolute mSASSS change score over 2 years was analysed using longitudinal generalised estimating equations analysis.
Results TNFi treatment in the current 2-year interval was not associated with retardation of radiographic spinal progression (β=−0.02 (95% CI −0.37 to 0.34) and −0.17 (95% CI −0.54 to 0.20) for any and ≥12 months treatment duration, respectively, adjusted for sex, the Ankylosing Spondylitis Disease Activity Score, smoking, presence of definite radiographic sacroiliitis, mSASSS at baseline and non-steroidal anti-inflammatory drug intake). TNFi treatment in the previous 2-year interval, was, however, significantly associated with reduction of mSASSS progression, which was especially evident in patients who received TNFi in the previous and in the current intervals: β=−0.58 (95% CI −1.02 to –0.13), adjusted for the same variables.
Conclusion TNFi treatment was associated with a time-shifted effect on radiographic spinal progression in axSpA that became evident between years 2 and 4 after treatment initiation.
- Tumor Necrosis Factor Inhibitors
- Spondylitis, Ankylosing
- Epidemiology
- Biological Therapy
Data availability statement
Data are available upon reasonable request. The original study data can be made available upon reasonable request that should be directed to the corresponding author.
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Data availability statement
Data are available upon reasonable request. The original study data can be made available upon reasonable request that should be directed to the corresponding author.
Footnotes
Handling editor Josef S Smolen
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Contributors All authors have made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; finally approved the version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. DP is responsible for the overall content as the guarantor and accepts full responsibility for the work, had access to the data and controlled the decision to publish.
Funding GESPIC has been financially supported by the German Federal Ministry of Education and Research (Bundesministerium für Bildung und Forschung-BMBF). As funding by BMBF was reduced according to schedule in 2005 and stopped in 2007, complementary financial support has been obtained also from Abbott/Abbvie, Amgen, Centocor, Schering-Plough, and Wyeth. Since 2010 GESPIC was supported by Abbvie, additional support has been obtained also from ANCYLOSS (grant number FKZ 01EC1002D), ArthroMark (grant numbers FKZ 01EC1009A and FKZ 01EC1401A), and METARTHROS (grant number FKZ 01EC1407A) projects funded by BMBF.
Competing interests VRR: reports grants and personal fees from Falk e.V., consulting fees from AbbVie. FP: reports grants and personal fees from Novartis and Lilly, and personal fees from AbbVie, AMGEN, BMS, Celgene, MSD, Pfizer, Roche, UCB, and Janssen. MP: reports personal fees from Novartis and UCB. JR: reports personal fees from Novartis and UCB. HH: reports consulting fees from Boehringer, Janssen, MSD, Novartis, Sobi; personal fees from MSD, Janssen, Roche, Pfizer, Novartis, AbbVie, and Sobi. JS: reports consulting fees from: AbbVie, Lilly, Merck, Novartis, UCB; consulting fees from: Abbvie, Lilly, Merck, Novartis, UCB; speaker fees from: Abbvie, Janssen, Lilly, Merck, Novartis, UCB; personal fees from: AbbVie. MR: reports personal fees from: Abbvie, Janssen, Eli Lilly, Novartis, Galapagos, Pfizer, and UCB; speaker fees from: Abbvie, Boehringer Ingelheim, Celgene, Chugai, BMS, Eli Lilly, Janssen, Novartis, Pfizer, UCB. DP: reports research support from: AbbVie, Eli Lilly, MSD, Novartis, Pfizer; consulting fees from: AbbVie, Biocad, Eli Lilly, Gilead, GlaxoSmithKline, Janssen, MSD, Novartis, Pfizer, Samsung Bioepis, and UCB; speaker fees from: AbbVie, Bristol-Myers Squibb, Eli Lilly, MSD, Novartis, Pfizer, and UCB.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
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