Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose: In patients with early axial spondyloarthritis (SpA) with a disease duration of < 5 years and evidence of active inflammation on whole-body magnetic resonance imaging (wb-MRI) in the spine and/or sacroiliac (SI-) joints at baseline [1] we assessed the degree of fluctuation of active inflammation (bone marrow edema/ osteitis) on MRI during treatment with 3 consecutive years with etanercept (ETN).
Methods:
In the previously reported ESTHER trial axial SpA patients were treated with ETN (n= 40) versus sulfasalazine (SSZ) (n= 36) in the first year [1]. All patients who were not in remission at week 48 (n=48) were either continuously treated with ETN, or sulfasalazine treatment was switched to ETN treatment. Wb-MRIs of those 40 patients who reached the end of year 4 were scored for active inflammation (osteitis) in the SI-joint quadrants and spine vertebral units (VUs). We here analysed MRI data in terms of osteitis in the pooled data set of 40 patients who were continously treated with ETN for 3 consecutive years. Data were analysed as observed. Scoring was performed by two radiologists, blinded for treatment arm and MRI time point. For this analysis, the presence or absence of osteitis were only counted if both scorers agreed.
Results:
At baseline there were 136 SI-joint quadrants with osteitis (according to both scorers). At year 2 osteitis disappeared in 50% of quadrants (68/136), at year 3 osteitis disappeared in 41% (56/136) of quadrants and osteitis disappeared at both year 2 and 3 in 32% (44/136).
In the spine at baseline 37 vertebral units (VUs) showed osteitis. Of these at year 2 osteitis disappeared in 65% (24/37), at year 3 in 57% (21/37) and in both year 2 and 3 in 51% (19/37).
Of the SI-joint quadrants which did not show osteitis (according to both scorers) at baseline (n= 131) the rate of new development of osteitis was 4% (5/131) at year 2; 7% (9/131) at year 3 and only 1.5% (2/131) at both year 2 and 3.
Of the spine vertebral units which did not show osteitis at baseline (n= 843) the rate of new development of osteitis was 0.8% (7/843) at year 2; 1.3% (11/843) at year 3 and 0.4% both at year 2 and 3.
The mean osteitis spine score (range 0-69) decreased from 1.6 (standard deviation 3.4) at baseline to 0.7 (1.4) at year 2 and 0.9 (1.8) at year 2. The mean SI-joint score (range 0-24) decreased from 6.8 (6.1) at baseline to 2.0 (2.2) at year 2 and 2.2 (2.5) at year 3.
Conclusion:
There was a consistently effective suppression of osteitis on MRI in patients with early axial SpA and only a very low rate of new onset of osteitis during 3 years of continous treatment with etanercept. Whether this also prevents the occurrence of bone proliferation has to be proven by longer follow-ups.
References:
- Song I.-H. Ann Rheum Dis. 2011;70 (4):590-596.
Disclosure:
I. H. Song,
Pfizer, Merck Sharp Dohme/Schering Plough, AbbVie ,
5;
K. G. A. Hermann,
None;
H. Haibel,
AbbVie,MSD, Chugai,
8,
AbbVie, MSD,
5;
C. Althoff,
None;
D. Poddubnyy,
Merck Sharp Dohme/Schering Plough, AbbVie,
5;
J. Listing,
None;
A. Weiss,
None;
E. Lange,
Pfizer Inc,
3;
B. Freundlich,
Pfizer Inc,
9;
M. Rudwaleit,
Pfizer, Merck Sharp Dohme/Schering Plough, AbbVie, UCB,
5;
J. Sieper,
Pfizer, Merck Sharp Dohme/Schering Plough, AbbVie, UCB,
5.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/effective-prevention-of-new-osteitis-on-magnetic-resonance-imaging-in-patients-with-early-axial-spondyloarthritis-during-3-years-of-continous-treatment-with-etanercept-data-of-the-esther-trial/