Torgutalp Murat, Rios Rodriguez Valeria, Dilbaryan Ani, Proft Fabian, Protopopov Mikhail, Verba Maryna, Rademacher Judith, Haibel Hildrun, Sieper Joachim, Rudwaleit Martin, Poddubnyy Denis
Department of Gastroenterology, Infectious Diseases and Rheumatology (Including Nutrition Medicine), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
Department of Internal Medicine, Moscow City Clinical Hospital, Moscow, Russia.
Ann Rheum Dis. 2022 Aug 11;81(9):1252-1259. doi: 10.1136/annrheumdis-2022-222324.
The objective of the current study was to analyse the association between treatment with tumour necrosis factor inhibitors (TNFi) and radiographic spinal progression in patients with axial spondyloarthritis (axSpA) from a long-term inception cohort.
A total of 243 patients with axSpA from the German Spondyloarthritis Inception Cohort with at least two sets of spinal radiographs obtained at least 2 years apart during a 10-year follow-up were included. Spinal radiographs were evaluated by three trained and calibrated readers according to the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). The association between the current TNFi, previous TNFi and radiographic spinal progression defined as the absolute mSASSS change score over 2 years was analysed using longitudinal generalised estimating equations analysis.
TNFi treatment in the current 2-year interval was not associated with retardation of radiographic spinal progression (β=-0.02 (95% CI -0.37 to 0.34) and -0.17 (95% CI -0.54 to 0.20) for any and ≥12 months treatment duration, respectively, adjusted for sex, the Ankylosing Spondylitis Disease Activity Score, smoking, presence of definite radiographic sacroiliitis, mSASSS at baseline and non-steroidal anti-inflammatory drug intake). TNFi treatment in the previous 2-year interval, was, however, significantly associated with reduction of mSASSS progression, which was especially evident in patients who received TNFi in the previous and in the current intervals: β=-0.58 (95% CI -1.02 to -0.13), adjusted for the same variables.
TNFi treatment was associated with a time-shifted effect on radiographic spinal progression in axSpA that became evident between years 2 and 4 after treatment initiation.
本研究的目的是分析来自一个长期起始队列的轴性脊柱关节炎（axSpA）患者使用肿瘤坏死因子抑制剂（TNFi）治疗与脊柱影像学进展之间的关联。
纳入了德国脊柱关节炎起始队列中的243例axSpA患者，这些患者在10年随访期间至少有两组间隔至少2年的脊柱X线片。由三名经过培训和校准的阅片者根据改良斯托克强直性脊柱炎脊柱评分（mSASSS）对脊柱X线片进行评估。使用纵向广义估计方程分析来分析当前TNFi、既往TNFi与定义为2年期间绝对mSASSS变化评分的脊柱影像学进展之间的关联。
在当前2年期间接受TNFi治疗与脊柱影像学进展延缓无关（对于任何治疗持续时间和≥12个月的治疗持续时间，β分别为-0.02（95%CI -0.37至0.34）和-0.17（95%CI -0.54至0.20），校正了性别、强直性脊柱炎疾病活动评分、吸烟、明确的影像学骶髂关节炎的存在、基线时的mSASSS和非甾体抗炎药的摄入）。然而，在前一个2年期间接受TNFi治疗与mSASSS进展的减少显著相关，这在既往和当前期间均接受TNFi治疗的患者中尤为明显：β=-0.58（95%CI -1.02至-0.13），校正了相同的变量。
TNFi治疗与axSpA患者脊柱影像学进展的时间依赖性效应相关，这种效应在治疗开始后2至4年变得明显。
