The effect of tumor necrosis factor-blockade on new bone formation in ankylosing spondylitis

Abstract Background The purpose of this study was to determine the prevalence of high disease activity as measured using the Ankylosing Spondylitis Disease Activity Score (ASDAS) in ankylosing spondylitis (AS) patients who nonetheless have low Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores after anti-tumor necrosis factor (TNF) treatment. Its clinical impact on anti-TNF survival was also investigated. Methods We conducted a single-centre retrospective cohort study of AS patients having low BASDAI scores (< 4) and available ASDAS-C-reactive protein (CRP) data after 3 months of first-line anti-TNF treatment. Patients were grouped into high-ASDAS (≥ 2.1) and low-ASDAS (< 2.1) groups according to the ASDAS-CRP after 3 months of anti-TNF treatment. Their characteristics were compared. And survival analyses were carried out using Kaplan–Meier curves and log-rank test with the event being discontinuation of anti-TNF treatment due to lack/loss of efficacy. Results Among 116 AS patients with low BASDAI scores after 3 months of anti-TNF treatment, 38.8% were grouped into the high-ASDAS group. The high-ASDAS group tended to have greater disease activity after 9 months of treatment (BASDAI 2.9 ± 1.1 vs. 2.3 ± 1.4, p=0.007; ASDAS-CRP 1.8 ± 0.6 vs. 1.5 ± 0.7, p=0.079; proportion of high ASDAS-CRP 27.8% vs. 13.8%, p=0.094) and greater risk of discontinuing anti-TNF treatment due to lack/loss of efficacy than the low-ASDAS group (p=0.011). Conclusions A relatively high proportion of AS patients with low BASDAI scores had high ASDAS-CRP. These low-BASDAI/high-ASDAS-CRP patients also had a greater risk for discontinuation of anti-TNF treatment due to low/lack of efficacy than the low-ASDAS group. The use of the ASDAS-CRP alone or in addition to the BASDAI may improve the assessment of AS patients treated with anti-TNF agents.

Download Full-text

Rebuttal letter on “Comment on Tumor necrosis factor inhibitors prevent structural damage in hips in ankylosing spondylitis—time to reconsider treatment guidelines? A case series and review of literature”

Clinical Rheumatology ◽

10.1007/s10067-021-05705-8 ◽

2021 ◽

Author(s):

Francisco Airton Castro Rocha ◽

Atul Deodhar

Keyword(s):

Ankylosing Spondylitis ◽

Tumor Necrosis Factor ◽

Structural Damage ◽

Tumor Necrosis ◽

Treatment Guidelines ◽

Case Series ◽

Tumor Necrosis Factor Inhibitors ◽

Review Of Literature ◽

Necrosis Factor

Download Full-text

Polymorphism within the tumor necrosis factor α (TNF) promoter region in patients with ankylosing spondylitis

Human Immunology ◽

10.1016/s0198-8859(98)00099-8 ◽

1999 ◽

Vol 60 (2) ◽

pp. 140-144 ◽

Cited By ~ 28

Author(s):

Eric L Kaijzel ◽

Brigitta M.N Brinkman ◽

Michiel V van Krugten ◽

Louise Smith ◽

Tom W.J Huizinga ◽

...

Keyword(s):

Ankylosing Spondylitis ◽

Tumor Necrosis Factor ◽

Promoter Region ◽

Tumor Necrosis ◽

Tumor Necrosis Factor Α ◽

Factor Α ◽

Necrosis Factor

Download Full-text

Tumor necrosis factor-α (TNFα) inhibitors in the treatment of nonradiographic axial spondyloarthritis: current evidence and place in therapy

Therapeutic Advances in Musculoskeletal Disease ◽

10.1177/1759720x17706454 ◽

2017 ◽

Vol 9 (8) ◽

pp. 197-210 ◽

Cited By ~ 7

Author(s):

Valeria Rios Rodriguez ◽

Denis Poddubnyy

Keyword(s):

Ankylosing Spondylitis ◽

Tumor Necrosis Factor ◽

Tumor Necrosis ◽

Tumor Necrosis Factor Α ◽

Axial Spondyloarthritis ◽

Efficacy And Safety ◽

Tnfα Inhibitors ◽

Factor Α ◽

Nonradiographic Axial Spondyloarthritis ◽

Necrosis Factor

Nonradiographic axial spondyloarthritis (SpA) and radiographic SpA (also known as ankylosing spondylitis) are currently considered as two stages or forms of one disease (axial SpA). The treatment with tumor necrosis factor-α (TNFα) inhibitors has been authorized for years for ankylosing spondylitis. In recent years, most of the anti-TNFα agents have also been approved for the treatment of nonradiographic axial SpA by the European Medicines Agency (EMA) and similar authorities in many countries around the world (but not in the US), increasing the number of possible therapies for this indication. Data from several clinical trials have demonstrated the good efficacy and safety profiles from those anti-TNFα agents. Presently, a large number of patients achieve a satisfactory clinical control with the current therapies, however, there remains a percentage refractory to nonsteroidal anti-inflammatory drugs (NSAIDs) and TNFα inhibitors; therefore, several new drugs are currently under investigation. In 2015, the first representative of a new class of biologics [an interleukin (IL)-17 inhibitor] secukinumab, was approved for the treatment of ankylosing spondylitis; a clinical trial in nonradiographic axial SpA is currently underway. In this review, we discuss the recent data on efficacy and safety of TNFα-inhibitors focusing on the treatment of nonradiographic axial SpA.

Download Full-text