TNF Inhibitors Decrease Extraarticular Manifestations in Ankylosing Spondylitis

ankylosing spondylitis
ankylosing spondylitis
Treatment with TNF inhibitors has led to improvement in physical function and quality of life in patients with ankylosing spondylitis.
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SAN DIEGO – Tumor necrosis factor (TNF) inhibitors were shown to reduce the incidence and prevalence of comorbidities and extraarticular manifestations among patients with ankylosing spondylitis, according to research to be presented at the American College of Rheumatology 2017 meeting, November 3-8, in San Diego, California.

In a retrospective cohort study of 3 commercial insurance claims databases (Multi-Payer Claims Database [MPCD; 2007-2010], Truven MarketScan® [2010-2014], and the US Medicare Fee-for-Service Claims data [2006-2014]), researchers evaluated 63,052 patients with ankylosing spondylitis who also had more than 6 months of baseline data and drug exposure following diagnosis. The prevalence of comorbidities and extraarticular manifestations at 6 months prediagnosis and postdiagnosis was compared among patients receiving conventional disease-modifying antirheumatic drugs (DMARDs), TNF inhibitors, or no therapy/nonsteroidal anti-inflammatory drugs (NSAIDs).

In at least one of the databases, patients who received TNF inhibitors had significantly lower rates of aortic insufficiency, conduction block, myocardial infarction, psoriasis, ulcerative colitis, Crohn disease, and uveitis compared with both those taking DMARDs and those receiving no therapy/NSAIDs.

Compared with no therapy/NSAIDs alone, patients who received TNF inhibitors had lower rates of uveitis and spinal cord compression.

The rates of restrictive lung disease were higher for users of TNF inhibitors compared with no therapy (P =.006 for MPCD; P <.001 for MarketScan® and Medicare) but not compared with DMARDs.

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According to the study authors, “this was the largest investigation of the prevalence and incidence of comorbidities and [extraarticular manifestations] of [ankylosing spondylitis] within the US, and suggests [TNF inhibitors] to be disease-modifying.” They acknowledge, however, that “in the absence of control for confounding, these findings should be considered preliminary.”

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Deodhar AA, Winthrop K, Chan B, et al. Do TNF inhibitors alter the natural history of ankylosing spondylitis by impacting the incidence and prevalence of comorbidities and extra-articular Manifestations? Presented at: 2017 ACR/ARHP Annual Meeting; November 3-8, 2017; San Diego, CA. Abstract 1527.