The following article is a part of conference coverage from the 2019 American College of Rheumatology/Association of Rheumatology Professionals (ACR/ARP) Annual Meeting, being held in Atlanta, Georgia. The team at Rheumatology Advisor will be reporting on the latest news and research conducted by leading experts in rheumatology. Check back for more from the 2019 ACR/ARP Annual Meeting.


ATLANTA —Tumor necrosis factor (TNF) inhibitors slow radiologic progression when compared to other drug classes in ankylosing spondylitis (AS), according to research presented at the 2019 American College of Rheumatology/Association of Rheumatology Professionals (ACR/ARP) Annual Meeting, held November 8 to 13, 2019, in Atlanta, Georgia.

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Researchers studied whether long-term treatment with TNF inhibitors might reduce radiographic progression in AS through a single-center, 18-year, longitudinal cohort study. Data were analyzed by the Modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS), erythrocyte sedimentation rate, C-reactive protein, and Bath Ankylosing Spondylitis Disease Activity Index.

The total cohort included 1280 patients, 328 of whom were treated with TNF inhibitors. In total, 2315 treatment intervals were obtained: 1063 intervals on TNF inhibitor therapy and 1252 intervals off TNF inhibitor therapy.


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Overall, the rate of mSASSS significantly decreased with the use of TNF inhibitors (b=-0.054; P =.023). The adjusted mSASSS rate was 0.916 per year while patients were on TNF inhibitors and 0.970 per year when patients were off TNF inhibitors.

However, investigators noted, the role of TNF inhibitor therapy was underestimated in terms of mSASSS due to “significantly higher” erythrocyte sedimentation rate and C-reactive protein values at the start of each interval among the “on” TNF inhibitor intervals (b=-5.946 and 0.412; P <.001 for both).

To eliminate these confounding effects, researchers created a pseudo population. Within this population, the mSASSS rate showed a greater decrease with the use of TNF inhibitors compared with the multivariable regression model (b=-0.111; P <.001). The adjusted mSASSS rates were 0.848 per year during on intervals and 0.959 per year during off intervals.

“TNF inhibitor treatment significantly slowed radiologic progression when compared to other therapies,” the researchers concluded. “In addition, the effect of TNF inhibitors on radiological progress has been previously underestimated.”

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Reference

Koo BS, Oh JS, Park SY, et al. Tumor necrosis factor inhibitors slow radiologic progression in patients with ankylosing spondylitis: 18-year longitudinal cohort study. Presented at: 2019 American College of Rheumatology/American Rheumatology Professionals Annual Meeting; November 8-13, 2019; Atlanta, GA. Abstract 933.