Baraliakos Xenofon, Gensler Lianne S, D'Angelo Salvatore, Iannone Florenzo, Favalli Ennio G, de Peyrecave Natasha, Auteri Simone E, Caporali Roberto
Rheumazentrum Ruhrgebiet Herne, Ruhr-Universität Bochum, Claudius Straße 45, 44649, Germany.
Department of Medicine/Rheumatology, University of California San Francisco, San Francisco, CA, USA.
Ther Adv Musculoskelet Dis. 2020 Mar 4;12:1759720X20906040. doi: 10.1177/1759720X20906040. eCollection 2020.
We aimed to perform a structured literature review of spinal radiographic progression, as assessed by the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS), in patients with ankylosing spondylitis (AS) or nonradiographic axial spondyloarthritis (nr-axSpA) treated with biologic therapy. Searches were limited to English language manuscripts published in the 11 years prior to 9 July 2019. Randomized controlled trials, open-label extensions (OLEs) and observational studies reporting mSASSS progression in patients with AS or nr-axSpA treated with biologics were eligible for inclusion. Bias was assessed using the methodological index for nonrandomized studies (MINORS) tool. Among the 322 studies identified in the literature search, 23 (11 OLEs and 12 cohort studies) met the eligibility criteria and were selected for inclusion. Most studies reported mSASSS progression in patients with AS receiving tumor necrosis factor inhibitor (TNFi) treatment. One study reported mSASSS progression in patients with AS treated with secukinumab, an interleukin-17A inhibitor. The mean (range) MINORS score was 11.3 (7-15) for the 15 noncomparative studies and 15 (12-22) for the 8 comparative studies. Although results of the individual studies were variable, mSASSS progression in patients with AS was generally minimal and slow with long-term TNFi therapy. Moreover, odds ratios for the likelihood of mSASSS progression with/without TNFi favoured TNFi therapy in several of the cohort studies. The rate of mSASSS progression following continuous secukinumab treatment was low and remained stable over 4 years. Of two studies reporting progression in patients with nr-axSpA treated with TNFis, one showed no mSASSS progression; however, the lack of control limited comparative conclusions.
我们旨在对强直性脊柱炎（AS）或非放射学中轴型脊柱关节炎（nr-axSpA）患者接受生物治疗后经改良斯托克强直性脊柱炎脊柱评分（mSASSS）评估的脊柱放射学进展进行结构化文献综述。检索限于2019年7月9日前11年内发表的英文手稿。报告AS或nr-axSpA患者接受生物制剂治疗后mSASSS进展的随机对照试验、开放标签扩展试验（OLE）和观察性研究均符合纳入标准。使用非随机研究的方法学指数（MINORS）工具评估偏倚。在文献检索中确定的322项研究中，23项（11项OLE和12项队列研究）符合纳入标准并被选入。大多数研究报告了接受肿瘤坏死因子抑制剂（TNFi）治疗的AS患者的mSASSS进展。一项研究报告了接受白细胞介素-17A抑制剂司库奇尤单抗治疗的AS患者的mSASSS进展。15项非对照研究的平均（范围）MINORS评分为11.3（7 - 15），8项对照研究的平均评分为15（12 - 22）。尽管个别研究结果存在差异，但长期TNFi治疗的AS患者的mSASSS进展通常极小且缓慢。此外，在一些队列研究中，使用/未使用TNFi的mSASSS进展可能性的优势比有利于TNFi治疗。连续使用司库奇尤单抗治疗后的mSASSS进展率较低，且在4年中保持稳定。在两项报告接受TNFi治疗的nr-axSpA患者进展的研究中，一项未显示mSASSS进展；然而，缺乏对照限制了比较结论。
