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

Vjara Popova; Seraphina Kissling; Raphael Micheroli; René Bräm; Manouk de Hooge; Xenofon Baraliakos; Michael J Nissen; Burkhard Möller; Pascale Exer; Michael Andor; Oliver Distler; Almut Scherer; Caroline Ospelt; Adrian Ciurea

doi:10.1186/s13075-023-03026-6

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. 2023 Mar 13;25(1):40. doi: 10.1186/s13075-023-03026-6.

Authors

Affiliations

¹ Department of Rheumatology, Zurich University Hospital, University of Zurich, Rämistrasse 100, CH-8091, Zurich, Switzerland.
² Swiss Clinical Quality Management Foundation, Statistics Group, Zurich, Switzerland.
³ Swiss Ankylosing Spondylitis Association, Zurich, Switzerland.
⁴ VIB Inflammation Research Center, Ghent University, Ghent, Belgium.
⁵ Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.
⁶ Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Bochum, Germany.
⁷ Department of Rheumatology, University Hospital Geneva, Geneva, Switzerland.
⁸ Deparment of Rheumatology and Immunology, University Hospital Bern, Bern, Switzerland.
⁹ Praxis Rheuma-Basel, Basel, Switzerland.
¹⁰ Rheumatology Practice, Uster, Switzerland.
¹¹ Department of Rheumatology, Zurich University Hospital, University of Zurich, Rämistrasse 100, CH-8091, Zurich, Switzerland. adrian.ciurea@usz.ch.

Abstract

Objectives: To analyse whether time-varying treatment with tumour necrosis factor inhibitors (TNFi) in radiographic axial spondyloarthritis (r-axSpA) has a differential impact on structural damage progression on different spinal segments (cervical versus lumbar spine).

Methods: Patients with r-axSpA in the Swiss Clinical Quality Management cohort were included if cervical and lumbar radiographs were available at intervals of 2 years for a maximum of 10 years. Paired radiographs were scored by two calibrated readers according to the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). The relationship between TNFi use and progression in the cervical and the lumbar spine was analysed using generalised estimating equation models and adjustment for potential confounding. Radiographic progression per spinal segment was defined as an increase of ≥ 1 mSASSS unit or by the formation of ≥ 1 new syndesmophyte over 2 years.

Results: Mean ± SD symptom duration was 13.8 ± 9.8 years. Mean ± SD mSASSS progression per radiographic interval was 0.41 ± 1.69 units in the cervical spine and 0.45 ± 1.45 units in the lumbar spine (p = 0.66). Prior use of TNFi significantly reduced the odds of progression in the cervical spine by 68% (OR 0.32, 95% CI 0.14-0.72), but not in the lumbar spine (OR 0.99, 95% CI 0.52-1.88). A more restricted inhibition of progression in the lumbar spine was confirmed after multiple imputation of missing covariate data (OR 0.43, 95% CI 0.24-0.77 and 0.85, 95% CI 0.51-1.41, for the cervical and lumbar spine, respectively). It was also confirmed with progression defined as formation of ≥ 1 syndesmophyte (OR 0.31, 95% CI 0.12-0.80 versus OR 0.56, 95% CI 0.26-1.24 for the cervical and lumbar spine, respectively).

Conclusion: Disease modification by treatment with TNFi seems to more profoundly affect the cervical spine in this r-axSpA population with longstanding disease. Site-specific analysis of spinal progression might, therefore, improve detection of disease modification in clinical trials in axSpA.

Keywords: Ankylosing spondylitis; Axial spondyloarthritis; Radiographic progression; Tumour necrosis factor inhibitor.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Disease Progression
Humans
Longitudinal Studies
Lumbar Vertebrae / diagnostic imaging
Lumbar Vertebrae / pathology
Severity of Illness Index
Spondylarthritis* / diagnostic imaging
Spondylarthritis* / drug therapy
Spondylitis, Ankylosing* / diagnostic imaging
Spondylitis, Ankylosing* / drug therapy
Spondylitis, Ankylosing* / pathology
Switzerland
Tumor Necrosis Factor Inhibitors / therapeutic use

Substances

Tumor Necrosis Factor Inhibitors