FRI0281 NON-STEROIDAL ANTI-INFLAMMATORY DRUGS IN PATIENTS WITH STABLE ANKYLOSING SPONDYLITIS RECEIVING TUMOR NECROSIS FACTOR INHIBITOR: CONTINUED VS WITHDRAWN
Authors: O. C. Kwon, J. H. Park, M. C. Park
Journal: Annals of the Rheumatic Diseases (2020)

Background: A recent recommendation from the American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network (ACR/SAA/SPARTAN) suggests withdrawing non-steroidal anti-inflammatory drugs (NSAIDs) in patients with stable ankylosing spondylitis (AS) receiving tumor necrosis factor inhibitor (TNFi) and NSAIDs. 1 However, the level of evidence for this statement is very low with lack of evidence supporting this recommendation. No studies have directly compared stable AS patients receiving TNFi with NSAIDs, and those receiving TNFi without NSAIDs. Objectives: To compare the disease activity in stable AS patients receiving TNFi, according to the use of NSAIDs. Methods: In total, 189 patients with stable AS receiving TNFi were included. Patients were classified into NSAID withdrawn group (n=48) and NSAID continued group (n=141), according to the use of NSAIDs. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were measured every 3 months, and Bath ankylosing spondylitis disease activity index (BASDAI) was measured every 6 months as parameters to evaluate disease activity. ESR, CRP, and BASDAI at each time point, and time-averaged values of each parameter during the observation period of one-year were compared between the two groups. Repeated-measure ANOVA was performed to compare changes in disease activity parameters during the observation period between the two groups. Table . Disease activity measures during observation period NSAID withdrawn (N = 48) NSAID continued (N = 141) P value At 3 months ESR (mm/hr), median (IQR) 5.0 (2.0–14.0) 7.0 (2.0–15.0) 0.712 CRP (mg/L), median (IQR) 0.5 (0.2–1.5) 0.8 (0.3–1.8) 0.613 At 6 months ESR (mm/hr), median (IQR) 5.0 (2.0–15.0) 7.0 (2.0–15.0) 0.278 CRP (mg/L), median (IQR) 0.6 (0.3–1.8) 0.8 (0.3–2.1) 0.335 BASDAI, mean ± SD 2.019 ± 0.569 2.226 ± 1.028 0.187 At 9 months ESR (mm/hr), median (IQR) 4.5 (2.0–13.8) 7.0 (2.8–17.0) 0.261 CRP (mg/L), median (IQR) 0.5 (0.3–1.6) 0.8 (0.3–2.2) 0.129 At 12 months ESR (mm/hr), median (IQR) 6.0 (2.0–13.0) 9.0 (3.0–19.0) 0.050 CRP (mg/L), median (IQR) 0.6 (0.3–2.1) 1.0 (0.4–3.1) 0.151 BASDAI, mean ± SD 2.168 ± 1.066 2.197 ± 1.002 0.867 Time-averaged values ESR (mm/hr), median (IQR) 5.3 (2.6–15.2) 8.4 (3.8–14.7) 0.096 CRP (mg/L), median (IQR) 0.8 (0.4–1.8) 1.1 (0.5–2.9) 0.136 BASDAI, mean ± SD 2.137 ± 0.557 2.227 ± 0.706 0.421 Abbreviations: NSAIDs, non-steroidal anti-inflammatory drugs; ESR, erythrocyte sedimentation rate; CRP, C-reactive protein; BASDAI, Bath ankylosing spondylitis disease activity index. Results: The level of ESR, CRP, and BASDAI at baseline and during the observation period did not differ between the two groups. The time-averaged values of ESR (p=0.096), CRP (p=0.136), and BASDAI (p=0.421), and changes of ESR (p=0.101), CRP (p=0.714), and BASDAI (p=0.613) during the observation period were not significantly different between the two groups. Conclusion: The continued use of NSAIDs in patients with stable AS receiving TNFi had no additional benefit in controlling the disease activity, as compared to patients who withdrew NSAIDs. Considering the risk of toxicity of long-term NSAID use, withdrawal of NSAIDs in stable AS patients receiving TNFi may be preferable. References: [1]Ward MM, Deodhar A, Gensler LS , et al. 2019 Update of the American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis. Arthritis Rheumatol 2019;71:1599-613 doi: 10.1002/art.41042. Acknowledgments: None. Disclosure of Interests: None declared