FRI0282 CONVENTIONAL DISEASE-MODIFYING ANTIRHEUMATIC DRUGS THERAPY HAS NO EFFICACY IN SLOWING SPINAL RADIOGRAPHIC PROGRESSION IN ANKYLOSING SPONDYLITIS: RESULTS FROM 18-YEAR LONGITUDINAL DATA
Authors: T. H. Lee, B. S. Koo, S. Lee, Y. K. Lee, J. S. Oh, S. Y. Park, T. H. Kim
Journal: Annals of the Rheumatic Diseases (2020)

Background: In the treatment of ankylosing spondylitis (AS), conventional disease-modifying antirheumatic drugs (cDMARDs) are generally recommended only in patients with peripheral arthritis. However in daily clinical practice, sulfasalazine (SSZ) and methotrexate (MTX) have still been considered on the basis of their anti-inflammatory effect when non-steroidal anti-inflammatory drugs (NSAIDs) are not available and when it is difficult to start tumor necrosis factor (TNF) inhibitors. Nonetheless there is few data about the impact of the cDMARDs on the prognosis of spinal progression. Objectives: The aim of this study was to investigate the effectiveness of SSZ and MTX on the spinal radiographic progression in patients with AS. Table 1. Association of clinical covariates and DMARD intervals with the rate of mSASSS change Variable Multivariate analysis Model 1 Model 2 β (95% CI) p β (95% CI) p On-DMARD intervals -0.081 (-0.276 to 0.115) 0.418 On-SSZ intervals -0.001 (-0.211 to 0.189) 0.913 On-MTX intervals -0.180 (-0.439 to 0.078) 0.172 Sex (female) -0.449 (-0.782 to -0.117) 0.008 -0.440 (-0.775 to -0.105) 0.010 Age 0.012 (-0.001 to 0.026) 0.061 0.012 (-0.001 to 0.025) 0.076 Eye involvement 0.572 (0.264 to 0.880) &lt; 0.001 0.577 (0.268 to 0.886) &lt; 0.001 Peripheral joint involvement -0.508 (-0.810 to -0.206) 0.001 -0.513 (-0.817 to -0.210) 0.001 HLA-B27 positivity † † NSAIDs † † Glucocorticoids † † ESR (log) 0.176 (0.087 to 0.265) &lt; 0.001 0.178 (0.088 to 0.268) &lt; 0.001 BASDAI (square root) † † †Not included in the model because the value did not show potentially significant association in univariate analysis (p &gt; 0.1). Methods: A total of 301 patients who have been treated with cDMARDs were enrolled from 1,280 patients in a single center cohort during 18 years of follow up. For each patient, time intervals of periods were created according to the prescription records. ‘On-DMARD’ intervals were time intervals of periods with SSZ or MTX treatment and ‘off-DMARD’ intervals were time intervals of periods without both SSZ and MTX treatment. The intervals were the periods excluding the treatment periods of TNF inhibitors. Radiographic progression was evaluated by the rate of Modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) change, an increase or decrease of mSASSS change per year. A generalized estimating equation models with adjustment for confounding covariates were used to evaluate the efficacy of cDMARDs on the radiographic progression. Results: The number of 732 on-DMARD intervals and 1,027 off-DMARD intervals were obtained. Among the on-DMARD intervals, the proportion of intervals treated with SSZ (on-SSZ intervals), MTX (on-MTX intervals) and both of them (on-SSZ/MTX intervals) were 96.2%, 19.9% and 16.1%, respectively. In the multivariable regression analysis, there was no significant decrease in the rate of mSASSS change during cDMARDs therapy (β = -0.081, p = 0.418) (Table 1). And the mean rate of mSASSS change were 0.61 during on-DMARD intervals and 0.69 during off-DMARD intervals after adjustment of other covariates. Conclusion: Treatment with cDMARDs in AS did not show significant impact in retarding spinal progression. In patients with AS, treatment with biologics rather than cDMARDs may be more effective in slowing radiographic progression. Disclosure of Interests: None declared