Spondyloarthritis & psoriatic arthritis
Site-specific assessment of spinal radiographic progression improves detection of TNF blocker-associated disease modification in axial spondyloarthritis: longitudinal observational data from the Swiss Clinical Quality Management Registry
Authors' conclusion
Disease modification by treatment with TNFi seems to more profoundly affect the cervical spine in this r-axSpA population with longstanding disease.
Study context
- Population
- Patients with radiographic axial spondyloarthritis (r-axSpA) in the Swiss Clinical Quality Management cohort with cervical and lumbar radiographs at 2-year intervals for up to 10 years
- Exposure
- Prior TNFi use vs no prior TNFi use, effect on progression in the cervical vs lumbar spine
- Outcome
- Radiographic progression per spinal segment (cervical, lumbar): increase of ≥ 1 mSASSS unit or formation of ≥ 1 new syndesmophyte
- Follow-up
- Over 2 years
Methodological detailsregistry-based, longitudinal observational, generalised estimating equation models, adjustment for potential confounding, Paired radiographs scored by two calibrated readers (modified Stoke Ankylosing Spondylitis Spine Score (mSASSS)), Mean ± SD symptom duration 13.8 ± 9.8 years
- Registry-based
- Longitudinal observational
- Generalised estimating equation models
- Adjustment for potential confounding
- Paired radiographs scored by two calibrated readers (mSASSS)
- Mean ± SD symptom duration 13.8 ± 9.8 years
Main finding
As reported in the abstract
Odds of radiographic progression with prior TNFi use, by spinal segment
Odds ratio (95% CI)
Prior TNFi (cervical spine)reduced odds of progression by 68%
0.32(0.14–0.72)
Prior TNFi (lumbar spine)
0.99(0.52–1.88)
Observational data: associations, not effects.
Further findings
mSASSS progression per radiographic interval, by spinal segment · 2 years
P = 0.66
Progression (≥ 1 mSASSS unit or ≥ 1 new syndesmophyte), cervical and lumbar spine, after multiple imputation of missing covariate data · 2 years
| OR (95% CI) | ||
|---|---|---|
| TNFiCervical spine · multiple imputation of missing covariate data | 0.43 (0.24–0.77) | |
| TNFiLumbar spine · multiple imputation of missing covariate data | 0.85 (0.51–1.41) | |
| 0.20.5125Odds ratio (log scale) |
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Site-specific assessment of spinal radiographic progression improves detection of TNF blocker-associated disease modification in axial spondyloarthritis: longitudinal observational data from the Swiss Clinical Quality Management Registry. Arthritis Res Ther. Published 13 March 2023. doi:10.
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