TNF blockers inhibit spinal radiographic progression in ankylosing spondylitis by reducing disease activity: results from the Swiss Clinical Quality Management cohort

Christoph Molnar, Almut Scherer, Xenofon Baraliakos, Manouk de Hooge, Raphael Micheroli, Pascale Exer, Rudolf O Kissling, Giorgio Tamborrini, Lukas M Wildi, Michael J Nissen, Pascal Zufferey, Jürg Bernhard, Ulrich Weber, Robert B M Landewé, Désirée van der Heijde, Adrian Ciurea, Rheumatologists of the Swiss Clinical Quality Management Program

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Abstract

OBJECTIVES: To analyse the impact of tumour necrosis factor inhibitors (TNFis) on spinal radiographic progression in ankylosing spondylitis (AS).

METHODS: 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.

RESULTS: 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).

CONCLUSION: 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.

Original languageEnglish
JournalAnnals of the Rheumatic Diseases
Volume77
Issue number1
Pages (from-to)63-69
ISSN0003-4967
DOIs
Publication statusPublished - Jan 2018

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Quality management
Tumor Necrosis Factor-alpha
Chronology
Sensitivity analysis

Keywords

  • Adult
  • Axis, Cervical Vertebra/diagnostic imaging
  • Cohort Studies
  • Disease Progression
  • Female
  • Follow-Up Studies
  • Humans
  • Lumbar Vertebrae/diagnostic imaging
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Radiography
  • Severity of Illness Index
  • Spine/diagnostic imaging
  • Spondylitis, Ankylosing/diagnostic imaging
  • Switzerland
  • Treatment Outcome
  • Tumor Necrosis Factor-alpha/antagonists & inhibitors

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Molnar, C., Scherer, A., Baraliakos, X., de Hooge, M., Micheroli, R., Exer, P., ... Rheumatologists of the Swiss Clinical Quality Management Program (2018). TNF blockers inhibit spinal radiographic progression in ankylosing spondylitis by reducing disease activity: results from the Swiss Clinical Quality Management cohort. Annals of the Rheumatic Diseases, 77(1), 63-69. https://doi.org/10.1136/annrheumdis-2017-211544
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 ; Rheumatologists of the Swiss Clinical Quality Management Program. / TNF blockers inhibit spinal radiographic progression in ankylosing spondylitis by reducing disease activity : results from the Swiss Clinical Quality Management cohort. In: Annals of the Rheumatic Diseases. 2018 ; Vol. 77, No. 1. pp. 63-69.
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title = "TNF blockers inhibit spinal radiographic progression in ankylosing spondylitis by reducing disease activity: results from the Swiss Clinical Quality Management cohort",
abstract = "OBJECTIVES: To analyse the impact of tumour necrosis factor inhibitors (TNFis) on spinal radiographic progression in ankylosing spondylitis (AS).METHODS: 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.RESULTS: 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).CONCLUSION: 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.",
keywords = "Adult, Axis, Cervical Vertebra/diagnostic imaging, Cohort Studies, Disease Progression, Female, Follow-Up Studies, Humans, Lumbar Vertebrae/diagnostic imaging, Male, Middle Aged, Multivariate Analysis, Radiography, Severity of Illness Index, Spine/diagnostic imaging, Spondylitis, Ankylosing/diagnostic imaging, Switzerland, Treatment Outcome, Tumor Necrosis Factor-alpha/antagonists & inhibitors",
author = "Christoph Molnar and Almut Scherer and Xenofon Baraliakos and {de Hooge}, Manouk and Raphael Micheroli and Pascale Exer and Kissling, {Rudolf O} and Giorgio Tamborrini and Wildi, {Lukas M} and Nissen, {Michael J} and Pascal Zufferey and J{\"u}rg Bernhard and Ulrich Weber and Landew{\'e}, {Robert B M} and {van der Heijde}, D{\'e}sir{\'e}e and Adrian Ciurea and {Rheumatologists of the Swiss Clinical Quality Management Program}",
note = "{\circledC} Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.",
year = "2018",
month = "1",
doi = "10.1136/annrheumdis-2017-211544",
language = "English",
volume = "77",
pages = "63--69",
journal = "Annals of the Rheumatic Diseases",
issn = "0003-4967",
publisher = "B M J Group",
number = "1",

}

Molnar, C, Scherer, A, Baraliakos, X, de Hooge, M, Micheroli, R, Exer, P, Kissling, RO, Tamborrini, G, Wildi, LM, Nissen, MJ, Zufferey, P, Bernhard, J, Weber, U, Landewé, RBM, van der Heijde, D, Ciurea, A & Rheumatologists of the Swiss Clinical Quality Management Program 2018, 'TNF blockers inhibit spinal radiographic progression in ankylosing spondylitis by reducing disease activity: results from the Swiss Clinical Quality Management cohort', Annals of the Rheumatic Diseases, vol. 77, no. 1, pp. 63-69. https://doi.org/10.1136/annrheumdis-2017-211544

TNF blockers inhibit spinal radiographic progression in ankylosing spondylitis by reducing disease activity : results from the Swiss Clinical Quality Management cohort. / 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; Rheumatologists of the Swiss Clinical Quality Management Program.

In: Annals of the Rheumatic Diseases, Vol. 77, No. 1, 01.2018, p. 63-69.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - TNF blockers inhibit spinal radiographic progression in ankylosing spondylitis by reducing disease activity

T2 - results from the Swiss Clinical Quality Management cohort

AU - Molnar, Christoph

AU - Scherer, Almut

AU - Baraliakos, Xenofon

AU - de Hooge, Manouk

AU - Micheroli, Raphael

AU - Exer, Pascale

AU - Kissling, Rudolf O

AU - Tamborrini, Giorgio

AU - Wildi, Lukas M

AU - Nissen, Michael J

AU - Zufferey, Pascal

AU - Bernhard, Jürg

AU - Weber, Ulrich

AU - Landewé, Robert B M

AU - van der Heijde, Désirée

AU - Ciurea, Adrian

AU - Rheumatologists of the Swiss Clinical Quality Management Program

N1 - © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

PY - 2018/1

Y1 - 2018/1

N2 - OBJECTIVES: To analyse the impact of tumour necrosis factor inhibitors (TNFis) on spinal radiographic progression in ankylosing spondylitis (AS).METHODS: 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.RESULTS: 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).CONCLUSION: 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.

AB - OBJECTIVES: To analyse the impact of tumour necrosis factor inhibitors (TNFis) on spinal radiographic progression in ankylosing spondylitis (AS).METHODS: 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.RESULTS: 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).CONCLUSION: 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.

KW - Adult

KW - Axis, Cervical Vertebra/diagnostic imaging

KW - Cohort Studies

KW - Disease Progression

KW - Female

KW - Follow-Up Studies

KW - Humans

KW - Lumbar Vertebrae/diagnostic imaging

KW - Male

KW - Middle Aged

KW - Multivariate Analysis

KW - Radiography

KW - Severity of Illness Index

KW - Spine/diagnostic imaging

KW - Spondylitis, Ankylosing/diagnostic imaging

KW - Switzerland

KW - Treatment Outcome

KW - Tumor Necrosis Factor-alpha/antagonists & inhibitors

U2 - 10.1136/annrheumdis-2017-211544

DO - 10.1136/annrheumdis-2017-211544

M3 - Journal article

C2 - 28939631

VL - 77

SP - 63

EP - 69

JO - Annals of the Rheumatic Diseases

JF - Annals of the Rheumatic Diseases

SN - 0003-4967

IS - 1

ER -