EULAR 2018 | Daily Highlights

TNF Inhibitors / NSSAID and Progression

COMBINED EFFECTS OF TUMOR NECROSIS FACTOR INHIBITORS AND NSAIDS ON RADIOGRAPHIC PROGRESSION IN ANKYLOSING SPONDYLITIS

Abstract: OP0198
Authors: L. S. Gensler et al.

» zum Abstract

Key content:
A total of 519 AS patients in this US cohort had at least 4 years of clinical and radiographic follow-up. Longitudinal models were used to assess the causal effect of TNF inhibitors and NSAIDs on retardation of radiographic progression after adjusting for sex, ethnicity, education, disease duration, enrollment year, treatment duration, baseline radiographic damage, ASDAS and current smoking. In the absence of NSAID use, TNF inhibition was not associated with less radiographic progression. The addition of NSAID therapy was associated with a decrease in radiographic progression in a dose-related manner after 4 years of treatment, particularly if celecoxib was used.

Relevance:
In contrast to other studies dealing with the role of TNF inhibitors in decreasing spinal radiographic progression in axSpA, this analysis suggests a synergistic effect of TNF inhibitors and high dose NSAID intake. TNF inihibitors alone might therefore not be effective in inhibiting progression. The results have to be interpreted with caution. Results from the SCQM cohort have clearly shown that TNF inhibition has an impact on radiographic progression by decreasing disease activity. Therefore, time-varying ASDAS has to be regarded as an intermediate variable and has to be excluded from the main statistical models. This was not done here. Whether there is no effect of TNFi monotherapy or whether it is masked by the ASDAS covariate cannot be interpreted from the limited information provided in the abstract. The synergistic role of TNF inhibitors and NSAIDS are currently assessed in ongoing randomized-controlled trials.

Zusammenfassung und Kommentar von:
PD Dr. Adrian Ciurea
Zürich