In patients with ankylosing spondylitis (AS) and nonradiographic axial spondyloarthritis (axSpA) who were treated with certolizumab pegol, rapid decreases in spinal and sacroiliac joint inflammation on magnetic resonance imaging (MRI) were maintained through 204 weeks, according to the results of the phase 3 randomized RAPID-axSpA study (ClinicalTrials.gov identifier: NCT01087762) published in Annals of the Rheumatic Diseases.

Patients who met Assessment of Spondyloarthritis International Society axSpA criteria with active disease were stratified using modified New York criteria. Researchers evaluated spinal radiographs with the modified Stoke Ankylosing Spondylitis Spine Score, and MRI inflammation was assessed with the Spondyloarthritis Research Consortium of Canada (SPARCC) score for sacroiliac joints and the Berlin spinal score. Remission was defined as SPARCC score <2 and Berlin spinal score ≤2.

Results showed that MRI improvements from baseline to 12 weeks were maintained through 204 weeks. SPARCC scores at baseline for patients with AS and nonradiographic axSpA were 8.5 and 7.5, respectively, which reduced to 1.3 and 2.4 at 204 weeks. In addition, Berlin scores at baseline were 7.4 and 4.4 for patients with AS and nonradiographic axSpA, which reduced to 2.6 and 1.9 at 204 weeks.


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Overall, 66.7% of patients with AS and 69.6% of those with nonradiographic axSpA who had baseline SPARCC scores ≥2, and 65.4% of patients with AS and 57.3% of those with nonradiographic axSpA who had baseline Berlin scores >2, achieved remission at 204 weeks.

The mean modified Stoke Ankylosing Spondylitis Spine Score change in AS was as follows: 0.98 (95% CI, 0.34-1.63) from baseline to 204 weeks, 0.67 (95% CI, 0.21-1.13) from baseline to 96 weeks, and 0.31 (95% CI, 0.02-0.60) from 96 to 204 weeks. Mean changes in nonradiographic axSpA were as follows: 0.06 (95% CI, –0.17 to 0.28) from baseline to 204 weeks, –0.01 (95% CI, –0.19 to 0.17) from baseline to 96 weeks, and 0.07 (95% CI, –0.07 to 0.20) from 96 to 204 weeks.

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Overall, 4.5% of patients with nonradiographic axSpA met modified New York criteria at 204 weeks, whereas 4.3% of those with AS no longer met these criteria.

The investigators concluded that 4-year spinal progression was low, with less progression reported during years 2 to 4 than during the first 2 years. Limited progression was observed with respect to changes in radiographic sacroiliac joint grading.

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Reference

van der Heijde D, Baraliakos X, Hermann KA, et al.  Limited radiographic progression and sustained reductions in MRI inflammation in patients with axial spondyloarthritis: 4-year imaging outcomes from the RAPID-axSpA phase III randomised trial [published online January 17, 2018]. Ann Rheum Dis. doi:10.1136/annrheumdis-2017-212377