Reduction in Spinal Radiographic Progression in Ankylosing Spondylitis Patients Receiving Prolonged Treatment With Tumor Necrosis Factor Inhibitors
Reduction in Spinal Radiographic Progression in Ankylosing Spondylitis Patients Receiving Prolonged Treatment With Tumor Necrosis Factor Inhibitors
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DOI：
10.1002/acr.23097
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发表时间：
2017-07-01
影响因子：
4.7
通讯作者：
Spoorenberg, Anneke
中科院分区：
文献类型：
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作者：
Maas, Fiona;Arends, Suzanne;Spoorenberg, Anneke
目标。对一大批接受肿瘤坏死因子（TNF）抑制剂治疗的强直性脊柱炎（AS）患者进行长达8年的随访，评估其脊柱影像学进展过程。从2004年至2012年Groningen Leeuwarden AS队列开始使用TNF抑制剂的连续患者被纳入。基线和两年一次的x线片与TNF-naive AS患者的x线片随机对照，并根据改良的斯托克强直性脊柱炎脊柱评分（mSASSS）按时间顺序评分。利用广义估计方程研究了射线照相的线性或非线性过程。主要分析在4年、6年和8年随访数据完整的患者中进行。敏感度分析是在对缺失的放射学数据进行单一线性输入，并对可能影响放射学进展的患者特征进行调整后进行的。基线时，210例纳入的AS患者的中位mSASSS为2.8（四分位数范围为0.0-12.0），平均+/- SD mSASSS为10.0 +/- 15.5。在前4年，x线摄影进展遵循线性过程（估计0-2年和2-4年的平均进展率为1.7）。在6年和8年的完整和输入数据的患者中发现偏离线性病程。在有完整8年数据的患者中，估计的平均2年进展率从2.3降至0.8。在调整基线mSASSS评分、有无综合征、性别、HLA-B27状态、年龄、症状持续时间、吸烟持续时间、体重指数、疾病活动性和非甾体类抗炎药使用情况后，发现相同的模式。这项针对长期接受TNF抑制剂治疗的AS患者的观察性队列研究显示，在4年多的随访后，脊柱放射学进展有所减少。
Objective. To evaluate the course of spinal radiographic progression for up to 8 years of followup in a large cohort of ankylosing spondylitis (AS) patients treated with tumor necrosis factor (TNF) inhibitors.Methods. Consecutive patients from the Groningen Leeuwarden AS cohort starting TNF inhibitors between 2004 and 2012 were included. Baseline and biannual radiographs were randomized with radiographs of TNF-naive AS patients and scored in chronologic order according to modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). The course of radiographic progression (linear or nonlinear) was investigated using generalized estimating equations. Primary analysis was performed in patients with complete data over 4, 6, and 8 years of followup. Sensitivity analysis was performed after single linear imputation of missing radiographic data and after adjusting for patient characteristics with possible influence on radiographic progression.Results. At baseline, median mSASSS of 210 included AS patients was 2.8 (interquartile range 0.0-12.0), mean +/- SD mSASSS 10.0 +/- 15.5. During the first 4 years, radiographic progression followed a linear course (estimated mean progression rate was 1.7 for 0-2 and 2-4 years). A deflection from a linear course was found in patients with complete and imputed data over 6 and 8 years. The estimated mean 2-year progression rate reduced from 2.3 to 0.8 in patients with complete 8-year data. The same pattern was found after adjustment for baseline mSASSS scores, presence of syndesmophytes, sex, HLA-B27 status, age, symptom duration, smoking duration, body mass index, disease activity, and nonsteroidal antiinflammatory drug use.Conclusion. This observational cohort study in AS patients receiving long-term TNF inhibitors showed a reduction in spinal radiographic progression after more than 4 years of followup.