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Treatment With TNF Inhibitors Slows Radiographic Progression in Ankylosing Spondylitis

Tumor necrosis factor inhibitors (TNFis) may slow radiographic progression in patients with ankylosing spondylitis (AS), according to study results published in Annals of the Rheumatic Diseases.

Previous studies have suggested that early and long-term treatment with TNFis, widely used as a second-line treatment in AS, can reduce radiographic progression in AS; however, the data are limited. The objective of the current study was to use 18-year longitudinal real-world data and determine the effect of long-term treatment with TNFis on radiographic progression in patients with AS.

Researchers reviewed data from electronic medical records of 1280 patients between January 2001 and December 2018, of whom 595 received TNFis and were followed up for 18 years. The study cohort included 338 patients (mean age at diagnosis, 33.1 years; 90% men), with ≥1 “on the TNFi” and ≥1 “off the TNFi” interval. Radiographic images of the cervical and lumbar spine of all patients were evaluated by 2 radiologists according to the modified Stroke Ankylosing Spondylitis Spinal Score (mSASSS).

Researchers obtained 2364 intervals, including 1281 (mean duration, 633.0 days) on the TNFi and 1083 (mean duration, 209.8 days) off the TNFi. In the multivariable model, increase in mSASSS change rate was associated with eye involvement (β=0.420; P =.005) and erythrocyte sedimentation rate at the start of the interval (β=0.199; P <.001); being women (β=−0.561; P=.001), Bath Ankylosing Spondylitis Disease Activity Index at the start of the interval (β=−0.225; P =.015), and TNFi therapy (β=−0.054; P =.022) were significantly associated with a decrease in mSASSS change rate.


In the multivariable regression model, the adjusted mSASSS changes per year with and without TNFis were 0.914 and 0.970, respectively; in the marginal structural model, the adjusted mSASSS changes were 0.848 and 0.960, respectively.

Researchers acknowledged study limitations, including missing data on smoking status, exclusion of TNFi-naive patients, and the potential differences between the imputed mSASSS data used in the study and the actual values.

“Compared with treatment without TNFis, treatment with TNFis slowed radiologic progression significantly,” concluded the researchers.


Koo BS, Oh JS, Park SY, et al. Tumour necrosis factor inhibitors slow radiographic progression in patients with ankylosing spondylitis: 18-year real-world evidence [published online July 13, 2020]. Ann Rheum Dis. doi:10.1136/annrheumdis-2019-216741,nppa,id_all,cimzia_march2019,cimzia_additionalmarch2019,id_nppa,enbrel_217283,mybetriq_2019,bms_orencia_221019,actemra_jan2020&hmSubId=&hmEmail=pYWLt4MKzOJthe1woSs_3jIZDo7e_i8h0&NID=1588807069&email_hash=888de3cbc406ce74a021d50cbba96025&mpweb=1323-101183-949697

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