#EULAR2018 – Combo of TNF Inhibitors, NSAIDs Fight Long-Term Radiographic Progression of AS

Use of nonsteroidal anti-inflammatory drugs (NSAIDs) in addition to tumor necrosis factor (TNF) inhibitors provides stronger long-term protective effects in patients with ankylosing spondylitis, according to recent clinical trial results.

The combo therapy prevented radiographic progression of the disease significantly during a four-year period compared to NSAIDs or TNF inhibitors alone.

The findings, “Combined effects of tumor necrosis factor inhibitors and NSAIDs on radiographic progression in ankylosing spondylitis,” were presented recently during the 2018 Annual European Congress of Rheumatology (EULAR), held in Amsterdam, the Netherlands.

“We welcome these results that support a potential disease modifying effect in patients with ankylosing spondylitis taking current therapies,” Robert Landewé, MD, PhD, said in a press release. Landewé is a professor at the University of Amsterdam and chairman of the Scientific Programme Committee of the EULAR meeting. “Radiographic progression has an important bearing on patient mobility, as well as affecting their general well-being and day-to-day living.”

NSAIDs are the first-line therapy to treat ankylosing spondylitis. TNF inhibitors are prescribed only if the patient has a poor response or is intolerant to NSAIDs. Although this strategy has proved to provide relief of symptoms, it is still not clear if this is the best clinical approach to prevent radiographic progression of the disease.

The study enrolled 519 patients with ankylosing spondylitis, of whom 75 percent were males who had the disease for a mean duration of 16.8 years. Initial evaluation of radiographic progression of the patients was of 14.2 mean points, as determined by the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). In the beginning of the study 66 percent of the patients were taking NSAIDs and 46 percent TNF inhibitors.

In patients taking TNF inhibitors, adding NSAID therapy was associated with less radiographic progression, in a dose-related manner, at 4 years of follow up. Patients taking only TNF inhibitors had a mSASSS value of 16.12, while those taking TNF inhibitors plus low- or high-dose NSAIDs had a 15.52 and 14.17 score, respectively.

Combo therapy also was more efficient to prevent radiographic progression of the disease compared to long-term use of NSAIDs alone at four years. Specifically, Celebrex (celecoxib) in combination with TNF inhibitors was the combination associated with the greatest reduction both at two and four years of follow-up.

“Our results suggest that the use of TNF inhibitors and NSAIDs, particularly celecoxib [Celebrex], have a synergistic effect to slow radiographic progression in ankylosing spondylitis patients, particularly at higher doses,” said lead study author Lianne Gensler, MD.