NSAID, TNFi Combination May Reduce Radiographic Progression in Ankylosing Spondylitis

Dose-related use of NSAIDs together with TNFi in patients with ankylosing spondylitis has a synergistic effect in slowing radiographic progression.
The following article is part of conference coverage from the European League Against Rheumatism (EULAR) Congress 2018 in Amsterdam, The Netherlands. Rheumatology Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in rheumatology. Check back for the latest news from EULAR 2018.

In patients with ankylosing spondylitis (AS) taking tumor necrosis factor inhibitors (TNFi), the use of nonsteroidal anti-inflammatory drugs (NSAIDs) is associated with reduced radiographic progression, according to data presented at the European League Against Rheumatism (EULAR) Congress held in Amsterdam, June 13 to 16, 2018.1 The greatest effect was observed in patients using both high-dose NSAIDs and TNFi.

Researchers sought to examine the effects of NSAIDs and TNFi on radiographic progression in ankylosing spondylitis and to compare the effects of celecoxib to other NSAIDs. A total of 519 patients (75% male; mean age, 41.4 years; mean symptom duration, 16.8 years) who met the modified New York criteria with at least 4 years of clinical and radiographic follow-up were included in the study. Investigators collected clinical and medication data every 6 months, and radiographs were performed at baseline and every 2 years.

The investigators estimated the causal effect of TNFi and NSAIDs on radiographic progression as measured by the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) at 2 and 4 years. Data were controlled for sex, race and ethnicity, education, symptom duration, enrollment year, number of years using TNFi, symptom duration at time of TNFi initiation, baseline mSASSS, Ankylosing Spondylitis Disease Activity Score, current smoking status, and missed visit status.

At baseline, NSAIDs were used in 66% of patients and TNFis were used in 46% of patients. Among patients who used TNFi, the addition of NSAID therapy was associated with reduced radiographic progression in a dose-related manner at 4 years. When researchers examined NSAID-specific effects, celecoxib in combination with TNFi use showed the greatest reduction in radiographic progression at 2 and 4 years.

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“Our results suggest that the use of TNF inhibitors and NSAIDs, particularly celecoxib, have a synergistic effect to slow radiographic progression in AS patients, particularly at higher doses,” said study author Lianne Gensler, MD, associate professor of medicine, University of California, San Francisco.2 “This is the first study to compare whether effects are comparable among different NSAIDs in this setting.”

Disclosures: L. Gensler Grant received research support from Amgen, AbbVie, and UCB, and is a consultant for Janssen, Lilly, Novartis; M. Weisman is a consultant for Celltrion, Baylx, Novartis, Lilly, and GSK; M. Brown Grant received research support from Abbvie, Janssen, UCB, and Leo Pharma, and is a consultant for Abbvie, Janssen, and Pfizer; J. Reveille received grant/research support from Lilly and UCB.

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  1. Gensler LS, Gianfrancesco M, Weisman MH, et al. Combined effects of tumor necrosis factor inhibitors and NSAIDs on radiographic progression in ankylosing spondylitis. Presented at: European League Against Rheumatism (EULAR) Congress 2018; June 13-16, 2018; Amsterdam, The Netherlands. Abstract OP0198.
  2. Combining NSAIDs and TNF inhibitors may reduce radiographic progression in ankylosing spondylitis [press release]. Amsterdam, The Netherlands: Annual European Congress of Rheumatology (EULAR) Congress 2018. Published June 14, 2018. Accessed June 14, 2018.