NSAID Use Associated With Lower Risk for MACE in Ankylosing Spondylitis

Use of NSAIDs and anti-TNF therapy is associated with a lower risk for major adverse cardiovascular events.

The use of nonsteroidal anti-inflammatory drugs (NSAIDs) is associated with a decreased risk for major adverse cardiovascular events (MACE) in patients with ankylosing spondylitis (AS), according to findings from a national cohort study published in Rheumatology.

The researchers collected patient data from the National Healthcare Data System, a French database containing hospitalization information.

Patients met inclusion criteria if they had a diagnosis of severe spondyloarthritis between January 2010 and December 2013; were actively being treated for AS; were newly receiving long-term illness benefits; and had an International Classification of Diseases, Tenth Revision (ICD-10) code diagnosis related to AS.

The primary study endpoint was the incidence of MACE, defined as the first occurrence of stroke or myocardial infarction.

The researchers identified 22,929 eligible patients, with a mean age of 43 (SD, 13.9) years.

NSAIDs and anti-TNFs may have a cardiovascular protective effect, unlike anti-IL17.

Overall, the 8-year cumulative incidence of MACE was 1.81% (95% CI, 1.61%-2.05%). Consistent with the French recommendations for first-line treatment, 86% of patients received NSAIDs upon diagnosis and 6% received antitumor necrosis factor (TNF) therapy.

Patients who received treatment with NSAIDs and anti-TNF medications had a significantly lower incidence of MACE (subhazard ratio [SHR], 0.39; 95% CI, 0.32-0.50; and SHR, 0.61; 95% CI, 0.46-0.80, respectively; P <.001). However, patients who received treatment with anti-interleukin (IL)-17 medications did not have a significantly lower incidence of MACE (SHR, 2.10; 95% CI, 0.79-5.57).

Limitations of the study included that the database from which patient data were pulled did not include information on clinical status, the level of disease activity, and inflammation levels. In addition, the researchers noted that patients were included in the study regardless of the dosing regimen of NSAIDs and that unreported over-the-counter NSAID use was not considered.

“In conclusion, we found few MACE in patients newly receiving [long-term illness benefits] for SpA. NSAIDs and [anti-TNFs] may have a cardiovascular protective effect, unlike anti-IL17” the study authors said. “These data are reassuring about the use of long-term NSAIDs in SpA,” they added.


Fakih O, Desmarets M, Martin B, et al. Impact of NSAIDs on 8-year cumulative incidence of major cardiovascular events in patients with ankylosing spondylitis: a nationwide study. Rheumatology (Oxford). Published online February 8, 2023. doi:10.1093/rheumatology/kead072