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Abstract Number: 975

The Effect of TNF Inhibition on Radiographic Progression in Ankylosing Spondylitis: An Observational Cohort Study of 374 Patients

Walter Maksymowych1, Yufei Zheng2, Stephanie Wichuk1, Sasha Bernatsky3, Praveena Chiowchanwisawakit4 and Robert G Lambert5, 1Medicine, Medicine, University of Alberta, Edmonton, AB, Canada, 2Alberta Institute of Health Economics, Edmonton, AB, Canada, 3Rheum/Clin. Epid., McGill MUHC/RVH, Montreal, QC, Canada, 4Rheumatology, Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand, 5Radiology, Radiology, University of Alberta, Edmonton, AB, Canada

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: anti-TNF therapy, radiography and spondylarthritis

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Session Information

Date: Sunday, November 8, 2015

Session Title: Spondylarthropathies and Psoriatic Arthritis - Clinical Aspects and Treatment: Treatment of AS

Session Type: ACR Concurrent Abstract Session

Session Time: 2:30PM-4:00PM

Background/Purpose: An analysis of radiographic
progression in an observational cohort has suggested that anti-TNF therapy lessens
radiographic progression, especially when treatment is introduced within 5
years of AS onset, although development of new syndesmophytes
was not reported1. We aimed to assess the impact of anti-TNF therapy
on radiographic progression in an observational cohort of AS by analyzing
propensity-matched patients.

Methods: In the FOllow-up
Research Cohort in AS (FORCAST), 374 patients with AS from Northern Alberta
attending community and academic rheumatology practices have been assessed over
a mean follow up of 3.1 years for clinical and laboratory outcomes every 6
months, and had spinal radiography at baseline and follow up. Patients received
standard (n=147) or anti-TNF therapy (n=227). Radiographs
were scored by two readers using the mSASSS with
adjudication by a third reader according to pre-specified rules
. The
impact of anti-TNF therapy was assessed using univariate
and multivariate Tobit regression for mSASSS data and Poisson regression for development of new syndesmophytes. Propensity matching was
based on a caliper of 0.1 in a logistic model using age,
gender, disease duration, smoking, mSASSS, and
pre-treatment BASDAI and CRP. Multiple propensity score analysis based on
multinomial logistic
regression was used to compare treatment groups according to disease duration
before start of anti-TNF. Missing values were imputed using the multiple imputation by chained equations (MICE) method.

Results: Subjects were predominantly males (74.9%)
of mean (SD) age 43.0 (11.9) years, mean (SD) disease duration 21.4 (11.6) years,
mean (SD) baseline mSASSS of 17.1 (18.4), mean (SD)
radiographic progression of 0.97 (1.31) mSASSS unit/year,
and 38.4% developed a new syndesmophyte. After
propensity matching using baseline covariates 218 and 230 patients could be
included in the post-match analysis of mSASSS
progression and new syndesmophytes, respectively.
These numbers were 158 and 190, respectively, after tighter matching using
pre-treatment covariates. In univariate analyses of
propensity-matched cases, significant predictors were baseline mSASSS and pre-treatment,ASDAS for mSASSS
progression, and baseline mSASSS and age for new syndesmophyte.  In
the final multivariable Tobit and Poisson regression
models using propensity-matched data, only pre-treatment ASDAS was a
significant predictor of mSASSS progression (β=0.40 [95%CI: 0.08-0.72]; p=0.014). Multiple propensity
score adjusted analyses demonstrated significantly less radiographic
progression in patients who received anti-TNF within 5 years of disease onset versus
those on standard therapy or treated with anti-TNF after >10 years of
disease (Table).

Conclusion: A beneficial effect of anti-TNF
treatment may be evident in AS patients receiving treatment within 5 years of
disease onset.

1.    
Haroon et al. Arthritis Rheum 2013; 65:
2645-54.

Significant variables in multiple propensity analysis

Coefficient

95% CI

P value

Baseline mSASSS

0.018

0.003 – 0.032

0.015

Baseline ASDAS

0.24

0.031 – 0.45

0.024

Time between disease onset and anti-TNF start:

No anti-TNF

<5 years

5-10 years

>10 years

REF

-1.41

-0.34

-0.17

-2.56 – -0.25

-1.30 – 0.62

-0.70 – 0.36

0.017

0.49

0.53

Time between disease onset and anti-TNF start:

No anti-TNF

<5 years

5-10 years

>10 years

0.17

-1.24

-0.17

REF

-0.36 – 0.70

-2.45 –  -0.022

-1.16 – 0.82

0.53

0.046

0.74


Disclosure: W. Maksymowych, Abbvie, Amgen, Boehringer Ingelheim, Eli Llilly and Company, Janssen Pharmaceutica Product, L.P., Pfizer, UCB, 5,Abbvie, 2; Y. Zheng, None; S. Wichuk, None; S. Bernatsky, None; P. Chiowchanwisawakit, None; R. G. Lambert, None.

To cite this abstract in AMA style:

Maksymowych W, Zheng Y, Wichuk S, Bernatsky S, Chiowchanwisawakit P, Lambert RG. The Effect of TNF Inhibition on Radiographic Progression in Ankylosing Spondylitis: An Observational Cohort Study of 374 Patients [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/the-effect-of-tnf-inhibition-on-radiographic-progression-in-ankylosing-spondylitis-an-observational-cohort-study-of-374-patients/. Accessed May 27, 2023.
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