ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 724

Diminished Spinal Radiographic Progression during Long-Term Treatment with TNF-α Inhibitors in Ankylosing Spondylitis Patients at Risk of Poor Radiographic Outcome

Fiona Maas1, Suzanne Arends1,2, Freke Wink2, Reinhard Bos2, Hendrika Bootsma3, Elisabeth Brouwer1 and Anneke Spoorenberg1,2, 1Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands, 2Rheumatology, Medical Center Leeuwarden, Leeuwarden, Netherlands, 3Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, The Netherlands, Groningen, Netherlands

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: ,

Session Information

Date: Sunday, November 13, 2016

Title: Spondylarthropathies and Psoriatic Arthritis – Clinical Aspects and Treatment - Poster I: Axial and Peripheral Spondyloarthritis – Clinical Aspects, Imaging and Treatment

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose:   In AS, spinal radiographic progression shows a very heterogeneous course. Our aim was to investigate which patient characteristics are of influence on the course of spinal radiographic progression in AS patients treated long-term with TNF-α inhibitors.

Methods: Consecutive patients from the Groningen Leeuwarden AS (GLAS) cohort who started TNF-α inhibitors, with baseline and biannual spinal radiographs until 6 years of follow-up were included. Radiographs were scored using mSASSS by two independent readers. Generalized estimating equations (GEE) were used to explore the associations between baseline characteristics and radiographic damage over time. The course of radiographic progression was investigated with different time functions (linear and non-linear), stratified for significantly associated patient characteristics. In case of missing radiographic data at one or more intermediate follow-up visits, single linear imputation was used.

Results: 80 AS patients reached 6 years of follow-up (mean mSASSS 8.2±12.9) of which 53 patients had complete radiographic data at all 2-year time points. Baseline syndesmophytes, male gender, older age, longer disease duration, and higher BMI were significantly associated with more radiographic damage over time. Baseline syndesmophytes was the only independent risk factor. GEE analysis in patients with these characteristics revealed that mSASSS progression followed a non-linear course; mean mSASSS progression rate reduced from maximal 2.8 units over 0-2 years to minimal 0.9 units over 4-6 years (Table 1). A linear course with overall lower progression scores over the 2-year intervals (≤1 mSASSS units/2yrs) was found in patients without risk factors (Table 1). Complete case analysis in 53 patients revealed similar results.

Conclusion: AS patients who are at risk of poor radiographic outcome showed the largest but diminishing spinal radiographic progression over time during long-term treatment with TNF-α inhibitors. Only little and linear progression was observed in patients without risk factors such as no syndesmophytes, shorter symptom duration, and normal BMI. Table 1. Radiographic damage at baseline and estimated mean spinal radiographic progression scores over time of AS patients stratified for baseline risk factors.

n

Baseline mSASSS

Best time model

mSASSS progression scores

0-2 year

2-4 year

4-6 year

Total group   80 8.7±13.3 Non-linear 1.7 1.5 1.0
Syndesmophytes Yes 43 15.8±14.9 Non-linear 2.8 2.5 1.6
No 37 0.4±0.8 Linear 0.4 0.4 0.4
Gender Male 56 10.9±14.6 Non-linear 2.1 1.9 1.3
Female 24 3.5±7.4 Linear 0.7 0.7 0.7
Age ≥40 years 43 12.3±15.2 Non-linear 2.3 2.0 1.3
<40 years 37 4.5±9.1 Linear 0.9 0.9 0.9
Symptom duration ≥10 years 52 12.3±15.2 Non-linear 2.3 2.0 1.3
<10 years 25 2.1±3.1 Linear 0.6 0.6 0.6
Time since diagnosis ≥5 years 44 11.4±15.2 Non-linear 2.2 1.9 1.3
<5 years 36 5.4±9.8 Linear 1.0 1.0 1.0
BMI ≥25 kg/m2 26 14.2±17.1 Non-linear 2.5 2.1 0.9
<25 kg/m2 22 3.5±6.8 Linear 0.9 0.9 0.9
Disclosure: F. Maas, None; S. Arends, Pfizer, 2; F. Wink, Abbvie, 5; R. Bos, None; H. Bootsma, None; E. Brouwer, Roche Pharmaceuticals, 5; A. Spoorenberg, Abbvie, Pfizer, UCB, 2,Abbvie, Pfizer, MSD, UCB, and Novartis, 5.

To cite this abstract in AMA style:

Maas F, Arends S, Wink F, Bos R, Bootsma H, Brouwer E, Spoorenberg A. Diminished Spinal Radiographic Progression during Long-Term Treatment with TNF-α Inhibitors in Ankylosing Spondylitis Patients at Risk of Poor Radiographic Outcome [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/diminished-spinal-radiographic-progression-during-long-term-treatment-with-tnf-%ce%b1-inhibitors-in-ankylosing-spondylitis-patients-at-risk-of-poor-radiographic-outcome/. Accessed .

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