Persistent reduction of spinal inflammation as assessed by magnetic resonance imaging in patients with ankylosing spondylitis after 2 yrs of treatment with the anti-tumour necrosis factor agent infliximab

Objective.Spinal inflammation and erosions have been described in magnetic resonance imaging (MRI) examinations of patients with ankylosing spondylitis (AS). MRI scoring systems have implemented these observations.Methods.MRI scans (T1 or short-tau inversion recovery) from tumor necrosis factor-α blocker (anti-TNF) trials with patients with active AS (n = 22) were analyzed at baseline and after 2 years based on vertebral units (VU). The analysis was based on the prevalence of spinal erosions in relation to inflammation (active erosions) or without it (inactive erosions) as an outcome measure on MRI and their course under anti-TNF therapy. The results of MRI scoring systems that include (ASspiMRI) or exclude (Berlin score) erosions were also compared.Results.At baseline, there were more VU with inflammation (33.7%) than with erosions irrespective of activity (10.6%). After 2 years, active erosions decreased to 3.7% while inflammation was seen in a total of 12% of VU — a reduction of 58.9% and 64.5%, respectively (both p < 0.02). The overall extent of erosions decreased from 10.6% at baseline to 5.6% at 2 years. At the patient level, 73% and 32% of patients showed active erosions (p = 0.002), while 100% and 64% of patients showed inflammation (p = 0.029) at baseline and 2 years, respectively. Both scoring systems showed similar improvement, independent of inclusion or exclusion of erosions.Conclusion.Inflammation with erosions was observed in the spine of most patients with AS but their contribution to changes observed upon anti-TNF therapy was small, indicating that erosions do not need to be included in quantitative scoring systems of inflammation. Spinal inflammation was still present after 2 years of anti-TNF therapy in two-thirds of patients.

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Early Transmural Response Assessed Using Magnetic Resonance Imaging Could Predict Sustained Clinical Remission and Prevent Bowel Damage in Patients with Crohn’s Disease Treated with Anti-Tumour Necrosis Factor Therapy

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjaa098 ◽

2020 ◽

Vol 14 (11) ◽

pp. 1524-1534

Author(s):

L Messadeg ◽

C Hordonneau ◽

G Bouguen ◽

F Goutorbe ◽

J M Reimund ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Crohn’S Disease ◽

Magnetic Resonance ◽

Crohn's Disease ◽

Tumour Necrosis Factor ◽

Therapeutic Efficacy ◽

Tumour Necrosis ◽

Activity Index ◽

Resonance Imaging ◽

Necrosis Factor

Abstract Background Magnetic resonance imaging [MRI] is a promising tool to evaluate therapeutic efficacy in ileocolonic Crohn’s disease [CD]. Aims We aimed to assess the feasibility of early MRI evaluation (week 12 [W12]) to predict corticosteroid-free remission [CFREM] at W52 and prevent long-term bowel damage. Methods All patients with active CD needing anti-tumour necrosis factor [anti-TNF] therapy were consecutively enrolled in this multicentre prospective study. MRI was performed before starting therapy, at W12 and W52. CFREM was defined as Crohn’s Disease Activity Index < 150, C-reactive protein < 5 mg/L and faecal calprotectin < 250 µg/g, with no switch of anti-TNF agents, no bowel resection and no therapeutic intensification between W12 and W52. Results Among 46 patients, 22 [47.8%] achieved CFREM at W52. Anti-TNF agents were able to heal almost all CD lesions as soon as W12 [p < 0.05]. Early transmural response defined as a 25% decrease of either Clermont score (odds ratio [OR] = 7.7 [1.7–34.0], p < 0.001) or Magnetic Resonance Index of Activity (OR = 4.2 [1.3–13.3], p = 0.015) was predictive of CFREM at W52. Achieving at least two items on W12-MRI among ulceration healing, disappearance of enlarged lymph nodes or sclerolipomatosis, ΔADC [apparent diffusion coefficient] > +10% or ΔRCE [relative contrast enhancement] > −30% was associated with a likelihood of CFREM at W52 of 84.6% vs 37.5% in patients without transmural response [p < 0.001]. Early transmural response could prevent bowel damage progression over time using Clermont score (hazard ratio = 0.21 [0.0–0.9]; p = 0.037). Conclusion Evaluation of early transmural response by MRI is feasible and is a promising end point to monitor therapeutic efficacy in patients with CD.

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FRI0420 Long term inhibition of IL-17a with secukinumab reduces spinal inflammation but has no influence on fatty lesions as assessed by magnetic resonance imaging in patients with ankylosing spondylitis

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2013-eular.1547 ◽

2013 ◽

Vol 72 (Suppl 3) ◽

pp. A516.1-A516

Author(s):

X. Baraliakos ◽

J. Braun ◽

D. Laurent ◽

D. Baeten ◽

D. van der Heijde ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Ankylosing Spondylitis ◽

Magnetic Resonance ◽

Resonance Imaging ◽

Spinal Inflammation

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Low-dose Infliximab (3 mg/kg) Significantly Reduces Spinal Inflammation on Magnetic Resonance Imaging in Patients with Ankylosing Spondylitis: A Randomized Placebo-controlled Study

The Journal of Rheumatology ◽

10.3899/jrheum.091043 ◽

2010 ◽

Vol 37 (8) ◽

pp. 1728-1734 ◽

Cited By ~ 40

Author(s):

WALTER P. MAKSYMOWYCH ◽

DAVID SALONEN ◽

ROBERT D. INMAN ◽

PROTON RAHMAN ◽

ROBERT G.W. LAMBERT

Keyword(s):

Magnetic Resonance Imaging ◽

Ankylosing Spondylitis ◽

Magnetic Resonance ◽

Treatment Effect ◽

Low Dose ◽

High Reliability ◽

Controlled Study ◽

Resonance Imaging ◽

Large Treatment Effect ◽

Spinal Inflammation

Objective.To evaluate the influence of low-dose infliximab (IFX) on spinal inflammation scored by magnetic resonance imaging (MRI). The dose recommended for rheumatoid arthritis (3 mg/kg) is also clinically effective for ankylosing spondylitis (AS), although effects on spinal inflammation as defined by MRI have yet to be described in a placebo-controlled trial.Methods.In a 12-week double-blind period, patients were randomized 1:1 to receive either IFX 3 mg/kg at 0, 2, and 6 weeks, or placebo. Spinal inflammation in discovertebral units (DVU) was measured by the Spondyloarthritis Research Consortium of Canada (SPARCC) MRI Index at baseline and 12 weeks by 3 readers blinded to timepoint and treatment allocation. We also compared reliability and discrimination of the SPARCC MRI index based on evaluation of the entire spine (23 DVU score) compared to assessment of only the 6 most severely affected DVU (6 DVU score).Results.At Week 12, patients treated with IFX experienced mean reductions of 55.1% and 57.2% in the 6 DVU and 23 DVU SPARCC scores, respectively, compared with a mean increase of 5.8% and decrease of 3.4% in 6 DVU and 23 DVU scores, respectively, for patients taking placebo (p < 0.001). A large treatment effect (Guyatt’s effect size ≥ 1.7) and high reliability was evident and comparable between 6 DVU and 23 DVU scoring methods.Conclusion.Treatment with low-dose IFX leads to a large treatment effect on spinal inflammation as measured by MRI. Scoring for inflammation of only the most severely affected regions of the spine by MRI is comparable to assessment of the entire spine.

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