Long-Term Anti-TNF Therapy May Slow Structural Damage in Early Axial Spondyloarthritis

Long-term treatment with the tumor necrosis factor (TNF) inhibitor etanercept appears to decelerate structural damage progression in the sacroiliac joints (SIJ) in patients with early axial spondyloarthritis (axSpA), according to study data published in Arthritis & Rheumatology.

Patients were selected for inclusion from the ESTHER trial (ClinicalTrials.gov identifier: NCT00844142). According to the study protocol, 76 patients with early axSpA (disease duration ≤5 years) who had active inflammatory lesions in either the SIJ or the spine were randomly assigned to receive treatment with etanercept (n=40) or sulfasalazine (n=36) for 1 year. At 1 year, all patients not in remission continued with etanercept or were reassigned to etanercept through 6 years. The present study cohort comprised ESTHER participants who had received etanercept treatment for up to 6 years and had available x-ray SIJ data. Two blinded readers scored the x-rays according to the modified New York criteria; a sacroiliitis sum score was calculated as the mean score between readers. Additionally, active and chronic inflammatory changes on magnetic resonance imaging (MRI) of SIJ at baseline, at 2 years, and at 4 years were assessed according to the Berlin MRI scoring system.

Of 76 initial ESTHER patients, 42 had SIJ x-ray data available at baseline and at least 1 follow-up time-point (2, 4, or 6 years). According to sacroiliitis sum score changes, SIJ radiographic progression declined over time. From baseline to 2 years, 2 to 4 years, and 4 to 6 years, the mean change in the sacroiliitis sum score was 0.13 ± 0.73, -0.27 ± 0.76, and -0.09 ± 0.68, respectively. According to longitudinal mixed model analyses, elevated C-reactive protein levels and presence of osteitis on MRI were independently associated with progression of the sacroiliitis sum score. These associations remained significant after adjusting for age, sex, HLA-B27 positivity, symptom duration, treatment duration with etanercept, intake of nonsteroidal anti-inflammatory drugs, and sacroiliitis sum score.

These data suggest that long-term anti-TNF treatment may decelerate structural damage to the SIJ in patients with early axSpA. As the study cohort was largely homogenous in axSpA activity, further research is necessary to confirm these findings. Even so, clinicians may find such data useful in individualizing treatment methods for patients with early axSpA.

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Reference

Rios Rodriguez V, Hermann KG, Weiß A, et al. Progression of the structural damage in the sacroiliac joints in patients with early axial spondyloarthritis during a long‐term anti‐TNF treatment: six‐year results of the ESTHER trial [published online January 9, 2019]. Arthritis Rheumatol. doi: 10.1002/art.40786