2359: Combination Of ­TNF Inhibitors And NSAIDs Versus ­TNF Inhibitors Alone On The Progression Of Structural Damage In The Spine And Hip: a Retrospective Study In 262 Patients With Radiographic Axial Spondyloarthritis

Background/Purpose: The inhibitory effect of TNF inhibitor (TNFi) treatment on spinal radiographic progression in patients with radiographic Axial Spondyloarthritis (r-axSpA), remains controversial. However, current evidence suggests that TNFi treatment seems to stabilize the structural damage of hip arthritis in these patients¹. The aim of this studyis to investigate whether the addition of an NSAIDS to TNFi therapy in patients with r-­axSpA, might have a better inhibitory effect on radiographic progression in the spine and hip, compared to TNFi therapy alone.

Methods: 262 patients with r-­axSpA [189 men; age: 44±12years, disease duration: 7.3 years (IQR:2;15)] were included. Radiographs of spine and pelvis, obtained at baseline (i.e., before TNFi initiation), compared retrospectively to those obtained after 2.5±0.7 and 7±2.3 years of TNFi combined, or not with NSAIDs. Spinal X-rays were scored by mSASSS. Both hips were scored by BASRI-hip score and mean joint space width (MJSW)¹. The spinal radiographic progression was assessed as the formation of new syndesmophytes (at corners with at least 1 at baseline) or ΔmSASSS-score/year ≥1 unit/year. Hip involvement was assessed radiographically as mean baseline BASRI-hip score ≥2. The significance of changes was tested by mixed linear models for longitudinal data.

Results: Combination therapy with TNFi and NSAIDs received 100/262 (38%) patients. Indeed, more females (52/73, 71%) than males (110/189, 58%), (p=0.052) were under concomitant NSAIDs. New syndesmophytes occurred in 58% of patients in TNFi monotherapy vs. 36% of those in concomitant NSAIDs (p=0.001). Moreover, the

ΔmSASSS-score/year was significantly higher in patients receiving only TNFi [0.7 (IQR:0.1;1.50], compared to those under combination therapy [0.1 (IQR:0;0.7], (p=0.0009).The mSASSS increased significantly both after 2.5±0.7 and 7±2.3 years of TNFi treatment. Nevertheless, the concomitant NSAIDs intake correlated negatively with the mSASSS (table 1). In patients with hip involvement at baseline, BASRI-hip score and MJSW did not change significantly during follow up (table 2). In those without baseline hip involvement, the BASRI-hip score remained unchanged after 2.5±0.7 years, but increased significantly compared to the baseline score after 7±2.3 years. The latter increase could be attributed to aging (b=0.007, CI:0.0006;0.01). In contrast, the MJSW did not change significantly during follow up (table 3). The NSAIDs co-administration had no effect on the evolution of both MJSW and BASRI-hip scores, irrespective of the baseline structural damage level (table 2 and 3).

Conclusion: Concomitant NSAIDs intake seems to have an inhibitory effect only on spinal radiographic progression but not on hip structural damage, compared to TNFi monotherapy in patients with r-axSpA. These different therapeutic outcomes could be attributed to the spinal osteoproliferative and peripheral osteodestructive changes, that occur in parallel in r-­axSpA.





References


1) Konsta M, Nurmohamed MT, Iliopoulos A et al. Prevalence and Radiographic Progression of Hip Involvement in Patients With Ankylosing Spondylitis Treated With Tumor Necrosis Factor Inhibitors. J Rheumatol. 2023;50:342-350