TNF inhibitors may slow long-term radiographic progression in AS
medwireNews: Tumor necrosis factor (TNF) inhibitors may reduce long-term radiographic progression at the spine in patients with ankylosing spondylitis (AS), results of a systematic review and meta-analysis show.
The analysis included data from 15 studies that compared radiographic outcomes between patients who were treated with TNF inhibitors and those who were biologic naïve.
Overall, Paras Karmacharya (Mayo Clinic, Rochester, Minnesota, USA) and colleagues found that mSASSS was lower among the patients who received TNF inhibitors relative to those who did not, but the mean differences of 0.73 points at 2 years and 2.03 points after 4 or more years of treatment were not statistically significant.
However, when the investigators restricted the analysis to the six trials with a low risk for bias, the mean mSASSS was a significant 2.17 points lower in the TNF inhibitor group than in the control group after 4 or more years of treatment.
The review also included six studies among patients receiving nonsteroidal anti‐inflammatory drugs (NSAIDs) and one among those receiving secukinumab but neither treatment resulted in significant slowing of radiographic progression relative to control treatments at 2 years, with mean mSASSS differences of –0.30 and –0.34 points, respectively.
No longer-term data were available for either of these two treatments, and there were also insufficient data to analyze outcomes among patients with nonradiographic axial spondyloarthritis (axSpA) for any of the treatments, the researchers note in Arthritis & Rheumatology.
They say: “Although our study showed a significant effect of TNF [inhibitors] on long-term radiographic progression (in sensitivity analysis), none of the included studies provide prospective, long-term controlled comparison.”
Karmacharya and co-authors therefore believe: “Further studies should explore the effect of NSAIDs and biologics alone and in combination in patients with early axSpA; their use in the group with high risk of progression should be evaluated with a follow up >4 years to see if effects are more pronounced over time.”
The study authors also call for “more sensitive and reliable measures to document radiographic progression.” They say that although mSASSS is “the most validated measure for radiographic progression in AS, it […] doesn’t include assessment of changes at [the] thoracic spine or posterior elements (facet joints), and cannot assess early damage.”
The team concludes: “Newer measures with higher sensitivity to detect structural changes, such as those based on quantitative low-dose [computed tomography] should be compared to mSASSS for use in clinical trials.”
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