Treatment with tumour necrosis factor inhibitors is associated with a time-shifted retardation of radiographic spinal progression in patients with axial spondyloarthritis.

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.

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Competing interests: VRR: reports grants and personal fees from Falk e.V., consulting fees from AbbVie. FP: reports grants and personal fees from Novartis and Lilly, and personal fees from AbbVie, AMGEN, BMS, Celgene, MSD, Pfizer, Roche, UCB, and Janssen. MP: reports personal fees from Novartis and UCB. JR: reports personal fees from Novartis and UCB. HH: reports consulting fees from Boehringer, Janssen, MSD, Novartis, Sobi; personal fees from MSD, Janssen, Roche, Pfizer, Novartis, AbbVie, and Sobi. JS: reports consulting fees from: AbbVie, Lilly, Merck, Novartis, UCB; consulting fees from: Abbvie, Lilly, Merck, Novartis, UCB; speaker fees from: Abbvie, Janssen, Lilly, Merck, Novartis, UCB; personal fees from: AbbVie. MR: reports personal fees from: Abbvie, Janssen, Eli Lilly, Novartis, Galapagos, Pfizer, and UCB; speaker fees from: Abbvie, Boehringer Ingelheim, Celgene, Chugai, BMS, Eli Lilly, Janssen, Novartis, Pfizer, UCB. DP: reports research support from: AbbVie, Eli Lilly, MSD, Novartis, Pfizer; consulting fees from: AbbVie, Biocad, Eli Lilly, Gilead, GlaxoSmithKline, Janssen, MSD, Novartis, Pfizer, Samsung Bioepis, and UCB; speaker fees from: AbbVie, Bristol-Myers Squibb, Eli Lilly, MSD, Novartis, Pfizer, and UCB.