TNF blockers inhibit spinal radiographic progression in ankylosing spondylitis by reducing disease activity: results from the Swiss Clinical Quality Management cohort.
TNF blockers inhibit spinal radiographic progression in ankylosing spondylitis by reducing disease activity: results from the Swiss Clinical Quality Management cohort.
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DOI：
10.1136/annrheumdis-2017-211544
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发表时间：
2018-01
影响因子：
27.4
通讯作者：
Rheumatologists of the Swiss Clinical Quality Management Program
中科院分区：
文献类型：
--
作者：
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
分析肿瘤坏死因子抑制剂（TNFis）对强直性脊柱炎（AS）脊柱放射学进展的影响。纳入了瑞士临床质量管理队列中的AS患者，随访时间长达10年，每2年进行一次影像学评估。由两名阅片员根据改良的斯托克强直性脊柱炎脊柱评分（mSASSS）和已知的时间顺序对X线片进行评分。使用二项广义估计方程模型，对2年放射学间隔前使用TNFi与间隔内进展之间的关系进行了研究，并对潜在混杂因素和缺失值的多重插补进行了校正。强直性脊柱炎疾病活动评分（ASDAS）被认为是介导TNFi对进展的影响，并在敏感性分析中加入模型。共有432例AS患者提供了616个影像学间期的数据。影像学进展定义为2年内mSASSS单位增加≥2。2年内平均（SD）mSASSS增加0.9（2.6）个单位。在多变量分析中，既往使用TNFi可使进展几率降低50%（OR 0.50，95% CI 0.28至0.88）。虽然在包括随时间变化的ASDAS的分析中，TNFi对进展没有直接影响（OR 0.61，95%CI 0.34至1.08），但通过ASDAS降低的间接影响具有统计学显著性（OR 0.75，95%CI 0.59至0.97）。肿瘤坏死因子与AS患者脊柱放射学进展减少相关。这种作用似乎通过TNFi对疾病活动的抑制作用介导。
To analyse the impact of tumour necrosis factor inhibitors (TNFis) on spinal radiographic progression in ankylosing spondylitis (AS). 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. 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). 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.
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影响因子：
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Haroon, Nigil;Inman, Robert D.;Learch, Thomas J.;Weisman, Michael H.;Lee, MinJae;Rahbar, Mohammad H.;Ward, Michael M.;Reveille, John D.;Gensler, Lianne S.
通讯作者：
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影响因子：
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