Radiographic progression in patients with ankylosing spondylitis after 2 years of treatment with the tumour necrosis factor   antibody infliximab

Introduction: Ankylosing spondylitis (AS) is an inflammatory rheumatic disease characterized by the development of osteoproductive changes in the spine which could possibly result in ankylosis. Treatment with tumour necrosis factor alpha (TNFα) inhibitors has proved to be an important step forward in the treatment of this disease, but for the time being it is not clear whether it favourably influences radiographic progression of the disease. Vascular endothelial growth factor most probably plays a role in the development of osteoproductive changes and recently its predictive influence on radiographic progression has been demonstrated. Bone morphogenic protein 2 (BMP-2) participates in the regulation of bone proliferation and its increased serum level has been demonstrated in patients with advanced AS and correlated with the degree of radiographic changes. Aim: The study aims to evaluate the VEGF and BMP-2 levels in patients with ankylosing spondylitis and how these levels relate to the concurrent treatment with TNFα inhibitors. Methods: Sera were evaluated from patients at the Rheumatologic Clinic of the Hradec Králové Faculty Hospital who fulfilled the modified New York Criteria for AS (n = 55). In these patients, the parameters of the activity of the disease (BASDAI = Bath Ankylosing Spondylitis Disease Activity Index, CRP = C-reactive protein) and the concurrent therapy (TNFα inhibitors, n = 21, vs. non-anti TNFα, n = 34) were recorded. The levels of VEGF and BMP-2 were analyzed using the ELISA method. Results: In patients treated with TNFα inhibitors, a significantly lower VEGF level was found when compared to untreated patients (140.3 (109.4; 262.2) vs. 261 (172.4; 396.6) pg/ml; p = 0.02). No difference was found between BMP-2 levels in both groups (treated vs. untreated patients) (254.8 (2301; 267.3) vs. 261.1 (248.6; 273.5) pg/ml; p = 0.24). A correlation analysis did not reveal any relationship between VEG F and BMP-2 (r = 0.057; p = 0.68). Serum levels of VEGF correlated with serum levels of CRP (r = 0.56; p = 0.00001) and the BASDAI value (r = 0.33; p = 0.015). Conclusion: Significantly lower VEGF levels were found in patients treated with TNFα inhibitors versus the untreated patients. These findings are in harmony with some hitherto published analyses and may give evidence of a favourable effect of TNFα inhibitors on radiographic progression. Neither influence on the BMP-2 level by treatment with TNFα inhibitors nor correlation with VEGF levels was demonstrated.

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SAT0372 Impact of Dose Tapering of Tumour Necrosis Factor-Blockers on Radiographic Progression in The Ankylosing Spondylitis – A 4 Year Prospective Follow Up from Single-Centre Cohort

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2016-eular.2337 ◽

2016 ◽

Vol 75 (Suppl 2) ◽

pp. 801.2-802

Author(s):

J.W. Park ◽

H.M. Kwon ◽

J.K. Park ◽

E.B. Lee ◽

Y.W. Song ◽

...

Keyword(s):

Ankylosing Spondylitis ◽

Tumour Necrosis Factor ◽

Tumour Necrosis ◽

Radiographic Progression ◽

Single Centre ◽

Necrosis Factor

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OP0198 Combined effects of tumour necrosis factor inhibitors and nsaids on radiographic progression in ankylosing spondylitis

10.1136/annrheumdis-2018-eular.4027 ◽

2018 ◽

Author(s):

L.S. Gensler ◽

M. Gianfrancesco ◽

M.H. Weisman ◽

M.A. Brown ◽

M. Lee ◽

...

Keyword(s):

Ankylosing Spondylitis ◽

Tumour Necrosis Factor ◽

Tumour Necrosis ◽

Radiographic Progression ◽

Combined Effects ◽

Tumour Necrosis Factor Inhibitors ◽

Necrosis Factor

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Tumour necrosis factor inhibitors slow radiographic progression in patients with ankylosing spondylitis: 18-year real-world evidence

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2019-216741 ◽

2020 ◽

Vol 79 (10) ◽

pp. 1327-1332 ◽

Cited By ~ 3

Author(s):

Bon San Koo ◽

Ji Seon Oh ◽

Seo Young Park ◽

Ji Hui Shin ◽

Ga Young Ahn ◽

...

Keyword(s):

Ankylosing Spondylitis ◽

Tumour Necrosis Factor ◽

Real World ◽

Tumour Necrosis ◽

Structural Model ◽

Radiographic Progression ◽

Change Rate ◽

Tumour Necrosis Factor Inhibitors ◽

Long Term Treatment ◽

Necrosis Factor

ObjectivesTumour necrosis factor inhibitors (TNFis) have been suggested to slow radiographic progression in patients with ankylosing spondylitis. However, limitations such as variations in disease activity, complex drug administration and short follow-up duration make it difficult to determine the effect of TNFis on radiographic progression. The aim of the study was to investigate whether long-term treatment with TNFis can reduce radiographic progression in patients with ankylosing spondylitis using 18-year longitudinal real-world data.MethodsThis retrospective study was conducted between January 2001 and December 2018 at a single centre. Among the 1280 patients whose electronic medical records were reviewed, data of 595 patients exposed to TNFis at least once were included. Among them, time intervals of TNFi exposure or non-exposure were determined in 338 patients (‘on the TNFis’ or ‘off the TNFis’ intervals, respectively). The difference in the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) change rate between ‘on the TNFis’ and ‘off the TNFis’ intervals was investigated.ResultsWe obtained 2364 intervals of 338 patients (1281 ‘on the TNFis’ and 1083 ‘off the TNFis’ intervals). In the marginal structural model for inverse probability of treatment weighting, the change rate of mSASSS significantly decreased with the use of TNFis (β=−0.112, p=0.004), and the adjusted mSASSS changes were 0.848 and 0.960 per year during ‘on the TNFis’ and ‘off the TNFis’ intervals, respectively.ConclusionCompared with treatment without TNFis, treatment with TNFis slowed radiologic progression significantly.

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