medwireNews: Ten-year results from the GESPIC study support the use of nonsteroidal anti-inflammatory drugs (NSAIDs) for reducing radiographic spinal progression in patients with axial spondyloarthritis (axSpA) and suggest a stronger effect with cyclo-oxygenase (COX)-2 selective inhibitors than non-selective NSAIDs.
The study included 243 patients with axSpA and at least two sets of radiographs taken at consecutive timepoints. Of these patients, 113 had radiographic axSpA with a symptom duration of up to 10 years, and 130 had nonradiographic axSpA with up to 5 years of symptom duration.
“These patients contributed a total 540 radiographic intervals in total,” said presenter Murat Torgutalp (Charité – Universitätsmedizin Berlin, Germany), who presented the findings at the EULAR 2022 Congress in Copenhagen, Denmark.
Clinical data were collected every 6 months for the first 2 years and then annually thereafter for up to 10 years, while spinal radiographs were collected every 2 years for the same duration up to a maximum of six timepoints.
Between radiographic intervals, 128 (23.7%) patients were taking COX-2 inhibitors and 289 (53.5%) were taking non-selective NSAIDs. The remaining 123 (22.8%) patients were not taking NSAIDs.
Torgutalp reported a smaller reduction in mSASSS score over 2 years with COX-2 inhibitors, compared with non-selective NSAIDs and no NSAIDs, with a mean change of 0.48 points versus 0.90 and 0.63 points, respectively.
This was the case for both patients with radiographic and nonradiographic axSpA. “As expected, the progression grades were numerically higher in patients with radiographic axSpA,” said Torgutalp.
He reported that in multivariable analysis adjusted for sex, symptom duration, ASDAS score, smoking, nSASSS, and tumor necrosis factor inhibitor use, a 10-point increase in Assessment of SpondyloArthritis International Society (ASAS) NSAID Intake Score was significantly associated with reduced radiographic spinal progression.
“This effect was more evident in the patients with radiographic axial spondyloarthritis,” Torgutalp pointed out.
When ASAS NSAID Intake Score was also taken into account, the team found that receiving any NSAID was associated with more spinal progression, compared with no NSAID, and this was numerically higher in intervals with non-selective NSAIDs.
By comparison, COX-2 inhibitor treatment was associated with reduced spinal progression compared with non-selective NSAIDs.
And after stratifying for NSAID type, a 10-point increase in NSAID Intake score was associated with reduced spinal progression for both non-selective NSAIDs and COX-2 inhibitors, with the greatest benefit seen in patients with radiographic axSpA and during intervals where COX-2 inhibitors were used.
Torgutalp concluded: “Higher non-steroid intake is associated with lower radiographic spinal progression, which can particularly be seen in patients with radiographic axSpA.
“COX-2 selective inhibitors might possess a stronger inhibitory effect on radiographic progression as compared to non-selective non-steroids.”
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