The impact of tumor necrosis factor α inhibitors on radiographic progression in ankylosing spondylitis.
The impact of tumor necrosis factor α inhibitors on radiographic progression in ankylosing spondylitis.
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DOI：
10.1002/art.38070
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发表时间：
2013-10
影响因子：
--
通讯作者：
Gensler, Lianne S.
中科院分区：
文献类型：
--
作者：
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.
我们研究了肿瘤坏死因子-α（TNF）抑制剂对强直性脊柱炎（AS）患者进行性脊柱损伤的影响。所有AS患者（满足改良纽约标准）前瞻性随访，并至少有两套脊柱X线片，最小间隔为1.5年（n = 334）。患者接受临床标准治疗，包括非甾体抗炎药和TNF抑制剂。影像学严重程度通过改良的Stokes强直性脊柱炎脊柱评分（mSASSS）进行评估。进展率超过1 mSASSS单位/年的患者被视为进展者。进行单变量和多变量回归分析。进行倾向评分匹配（PSM）和敏感性分析。使用零膨胀负二项（ZINB）模型分析TNF抑制剂对不同随访期mSASSS变化的影响。模型中包括潜在的混杂因素，如Bath AS疾病活动指数（BASDAI）、ESR、CRP、HLA-B27、性别、发病年龄、吸烟和基线损害。TNF抑制剂治疗与进展几率降低50%相关（OR：0.52; CI：0.30 - 0.88; p = 0.02）。与开始治疗时间较早的患者相比，延迟开始治疗时间超过10年的患者更有可能进展（OR = 2.4; 95% CI：1.09 - 5.3; p = 0.03）。在ZINB模型中，当X射线之间的差距超过3.9年时，TNF抑制剂的使用显著降低了进展。倾向评分匹配后，TNF抑制剂的保护作用更强。TNF抑制剂似乎可以减少AS的放射学进展，特别是早期启动和随访时间较长。
We studied the effect of Tumor Necrosis Factor-Alpha (TNF)-inhibitors on progressive spine damage in Ankylosing Spondylitis (AS) patients. All AS patients (satisfying the modified New York criteria) prospectively followed and with at least two sets of spinal radiographs at a minimum gap of 1.5 years were included (n=334). Patients received clinical standard of care, which included non-steroidal anti-inflammatory drugs and TNF-inhibitors. Radiographic severity was assessed by the modified Stokes Ankylosing Spondylitis Spine Score (mSASSS). Patients with a rate of progression more than 1 mSASSS unit/year were considered progressors. Univariable and multivariable regression analyses were done. Propensity score matching (PSM) and sensitivity analysis were performed. A zero-inflated negative binomial (ZINB) model was used to analyze the effect of TNF-inhibitor on change in mSASSS with varying follow-up periods. Potential confounders like Bath AS Disease Activity Index (BASDAI), ESR, CRP, HLA-B27, gender, age of onset, smoking and baseline damage were included in the model. TNF-inhibitor treatment was associated with a 50% reduction in the odds of progression (OR: 0.52; CI: 0.30-0.88; p=0.02). Patients with a delay in starting therapy of more than 10 years were more likely to progress compared to those who started earlier (OR=2.4; 95% CI: 1.09-5.3; p=0.03). In the ZINB model TNF-inhibitor use significantly reduced progression when the gap between x-rays was more than 3.9 years. The protective effect of TNF-inhibitors was stronger after propensity score matching. TNF-inhibitors appear to reduce radiographic progression in AS, especially with early initiation and longer duration of follow up.
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影响因子：
27.4
作者：
Lee, Wonuk;Reveille, John D.;Weisman, Michael H.
通讯作者：
Weisman, Michael H.
影响因子：
27.4
作者：
Poddubnyy, Denis;Rudwaleit, Martin;Sieper, Joachim
通讯作者：
Sieper, Joachim
影响因子：
--
作者：
Inman, Robert D.;Davis, John C., Jr.;Braun, Juergen
通讯作者：
Braun, Juergen
影响因子：
4.9
作者：
van der Heijde D;Salonen D;Weissman BN;Landewé R;Maksymowych WP;Kupper H;Ballal S;Gibson E;Wong R;Canadian (M03-606) study group;ATLAS study group
通讯作者：
ATLAS study group
影响因子：
--
作者：
Wanders, A;van der Heijde, D;Dougados, M
通讯作者：
Dougados, M