Molnar Christoph, Scherer Almut, Baraliakos Xenofon, de Hooge Manouk, Micheroli Raphael, Exer Pascale, Kissling Rudolf O, Tamborrini Giorgio, Wildi Lukas M, Nissen Michael J, Zufferey Pascal, Bernhard Jürg, Weber Ulrich, Landewé Robert B M, van der Heijde Désirée, Ciurea Adrian
Stastistics Group, Swiss Clinical Quality Management Foundation, Zurich, Switzerland.
Ruhr-University Bochum, Rheumazentrum Ruhrgebiet Herne, Herne, Germany.
Ann Rheum Dis. 2018 Jan;77(1):63-69. doi: 10.1136/annrheumdis-2017-211544. Epub 2017 Sep 22.
To analyse the impact of tumour necrosis factor inhibitors (TNFis) on spinal radiographic progression in ankylosing spondylitis (AS).
Patients with AS in the Swiss Clinical Quality Management cohort with up to 10 years of follow-up and radiographic assessments every 2 years were included. Radiographs were scored by two readers according to the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) with known chronology. The relationship between TNFi use before a 2-year radiographic interval and progression within the interval was investigated using binomial generalised estimating equation models with adjustment for potential confounding and multiple imputation of missing values. Ankylosing Spondylitis Disease Activity Score (ASDAS) was regarded as mediating the effect of TNFi on progression and added to the model in a sensitivity analysis.
A total of 432 patients with AS contributed to data for 616 radiographic intervals. Radiographic progression was defined as an increase in ≥2 mSASSS units in 2 years. Mean (SD) mSASSS increase was 0.9 (2.6) units in 2 years. Prior use of TNFi reduced the odds of progression by 50% (OR 0.50, 95% CI 0.28 to 0.88) in the multivariable analysis. While no direct effect of TNFi on progression was present in an analysis including time-varying ASDAS (OR 0.61, 95% CI 0.34 to 1.08), the indirect effect, via a reduction in ASDAS, was statistically significant (OR 0.75, 95% CI 0.59 to 0.97).
TNFis are associated with a reduction of spinal radiographic progression in patients with AS. This effect seems mediated through the inhibiting effect of TNFi on disease activity.
分析肿瘤坏死因子抑制剂（TNFis）对强直性脊柱炎（AS）脊柱影像学进展的影响。
纳入瑞士临床质量管理队列中患有AS且随访时间长达10年、每2年进行一次影像学评估的患者。由两名阅片者根据已知时间顺序的改良斯托克强直性脊柱炎脊柱评分（mSASSS）对X线片进行评分。使用二项广义估计方程模型研究在2年影像学间隔之前使用TNFi与该间隔内进展之间的关系，并对潜在混杂因素进行调整以及对缺失值进行多重插补。强直性脊柱炎疾病活动评分（ASDAS）被视为介导TNFi对进展的影响，并在敏感性分析中添加到模型中。
共有432例AS患者提供了616个影像学间隔的数据。影像学进展定义为2年内mSASSS单位增加≥2。2年内mSASSS平均增加（标准差）为0.9（2.6）个单位。在多变量分析中，先前使用TNFi使进展的几率降低了50%（OR 0.50，95%CI 0.28至0.88）。在包括随时间变化的ASDAS的分析中，TNFi对进展没有直接影响（OR 0.61，95%CI 0.34至1.08），但通过降低ASDAS产生的间接影响具有统计学意义（OR 0.75，95%CI 0.59至0.97）。
TNFis与AS患者脊柱影像学进展的减少有关。这种效应似乎是通过TNFi对疾病活动的抑制作用介导的。
