Artikel
Long-term anti-TNF treatment is associated with reduction of progression of radiographic changes in the sacroiliac joints in patients with non-radiographic axial SpA: six-year results of the ESTHER trial
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Autoren
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Valeria Rios Rodriguez
- Charité - Universitätsmedizin Berlin, Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektologie, Rheumatologie, Berlin
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Joachim Sieper
- Charité - Universitätsmedizin Berlin, Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektologie, Rheumatologie, Berlin
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Kay-Geert Hermann
- Charité - Universitätsmedizin Berlin, Radiologie, Berlin
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Hildrun Haibel
- Charité - Universitätsmedizin Berlin, Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektologie, Rheumatologie, Berlin
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Christian E. Althoff
- Charité - Universitätsmedizin Berlin, Radiologie, Berlin
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Beate Buß
- Charité - Universitätsmedizin Berlin, Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektologie, Rheumatologie, Berlin
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Olaf Behmer
- Pfizer Pharma GmbH, Berlin
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Denis Poddubnyy
- Charité - Universitätsmedizin Berlin, Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektologie, Rheumatologie, Berlin
| Veröffentlicht: | 29. August 2016 |
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Gliederung
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Background: It is currently not known, whether anti-TNF treatment might be able to prevent radiographic progression in sacroiliac joints (SIJ) in patients with axial spondyloarthritis (axSpA).
The objective of the current work was to assess the radiographic progression in SIJ during long-term (up to 6 years) treatment with the TNF-blocker etanercept in patients with early axSpA.
Methods: In the ESTHER trial a total of 76 patients with early (up to 5 years symptom duration) active axSpA were randomized to be treated with either etanercept or sulfasalazine for one year with a possibility to enter a long-term study extension with etanercept thereafter. X-rays of SIJ were collected at baseline and every 2 years thereafter till year 6. Two trained readers, who were blinded for all clinical data, scored independently the SIJ x-rays in a concealed and randomly selected order, according to the grading system of the modified New York (mNY) criteria for AS. Patients were classified as having AS if both readers recorded the presence of definite radiographic sacroiliitis according to the mNY criteria.
Results: A total of 55 patients from the 76 patients of ESTHER trial were included in the current analysis due to the availability of X-rays of SIJ. 19 patients (34.5%) were classified at baseline as AS and 36 (65.5%) as nr-axSpA. Radiographic progression from nr-axSpA to AS was observed mainly between baseline and year 2 – in 18.5% (5/27) of the patients classified as nr-axSpA at baseline with available SIJ X-rays at year 2. There were no patients who progressed to AS between year 2 and year 4 and only one patient (5.6%, 1/18) progressed to AS between year 4 and year 6 (Figure 1 [Fig. 1]).
Elevated CRP and higher at baseline showed a strong signal for an association with progression from nr-axSpA to AS after 2 years: odds ratio = 7.0 (95%CI 0.7-73.9). Furthermore, progressors had higher fatty lesions MRI score at baseline as compared to non-progressors: 10.3±7.1 vs. 4.9±5.8, respectively, p=0.064.
Conclusion: In the ESTHER trial, there was a substantial reduction of radiographic sacroiliitis progression between year 2 and year 6 of anti-TNF treatment. Higher baseline CRP and higher MRI fatty lesions score demonstrated a positive association with progression from nr-axSpA to AS.
