COMPARISON OF THE EFFECT OF TREATMENT WITH NSAIDS ADDED TO ANTI-TNF THERAPY VERSUS ANTI-TNF THERAPY ALONE ON PROGRESSION OF STRUCTURAL DAMAGE IN THE SPINE OVER TWO YEARS IN PATIENTS WITH ANKYLOSING SPONDYLITIS (CONSUL) – AN OPEN-LABEL, RANDOMIZED CONTROLLED, MULTICENTER TRIAL
Authors: F. Proft et al.
There is some evidence that NSAIDs may slow radiographic progression in ankylosing spondylitis (see also OP0021 EULAR 2022). Also for TNF-inhibitors retardation of radiographic progression was shown, at least in patients with 4 years or more of therapy. Whether NSAIDs have an additional benefit to anti-TNF therapy for prevention of structural damage in the spine is unknown. This randomized controlled trial evaluated the radiographic progression by mSASSS after 2 years of therapy with a TNF-inhibitor with or without additional therapy with Celecoxib. There were no significant differences in the mSASSS between the two groups, but a tendency for a lower number of new syndesmophytes in the combination group.
This data reminds me of the pivotal studies of Costadino Pitzalis group studying synovial tissue in RA patients that The data suggest that combination therapy with a TNF inhibitor and NSAIDs, with the aim of lowering radiographic progression, cannot be generally recommended. However, based on a tendency of fewer syndesmophytes seen in the study, could be considered in patients at high risk for progression.