Combo therapy slows progression in arthritis

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Combo therapy slows progression in arthritis

Ankylosing spondylitis is a painful and progressive form of arthritis which causes inflammation in the spine and other joints. According to new research,  progression of ankylosing spondylitis can be slowed down when tumor necrosis factor inhibitors (TNFi)  are added to high-dose nonsteroidal anti-inflammatory drugs (NSAIDs). This can be attributed to a synergistic effect between TNFi and NSAIDs.

Researchers at the University of California, together with other investigators, analysed the direct and interactive effects of a combination of the two therapies on X-ray progression of ankylosing spondylitis. According to Gensler L S, the lead author of the study, “Until 2003, the only drugs available to treat ankylosing spondylitis were NSAIDs. When the first TNFi was approved in 2003, the disease state changed. Suddenly, we could offer therapies to patients with incredible efficacy." However, despite the robust clinical response, TNFi could not show the disease progression (by X-ray) slowing down, Dr Gensler noted.

Researchers posited that can be a different mechanism to explain the damage that occurred in ankylosing spondylitis, and that though the inflammation is being treated, we may not be addressing the ankylosis that appeared to continue. At the same time, several studies came out looking at NSAIDs to see if they could slow down the progression, and these results were mixed. .

The study examined a cohort of 527 patients, 76% of whom were male with a baseline average age of 42 years old and an average disease duration of 18.45 years. Progression was defined as an increase of two or more units in modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). Their baseline median mSASSS score was 5.36, and they were followed for a median of 3.67 years.

After multivariate analysis of the results, it was evinced that there was a significant interaction between NSAIDs and TNFi. This indicated  that patients using TNFi with high dose NSAID (at least 50 percent of the maximum daily dose), had around 70% reduction in radiographic progression.

“This is the first study to show this relationship and potentially sheds light on why prior study results have been so controversial,” said Gensler. The researchers will next analyse another year’s worth of data to clarify their findings even more, Gensler told. It is also important to remember that this is a cohort of patients being studied, not a randomised controlled trial, so there may be unmeasured confounders and biases with regards to why various medications are used by different patients. In future, a randomised controlled trial with a radiographic outcome may allow us to answer the question in the purest way.


Spinal news international

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Original title of article:

Combination of NSAIDs and TNF-inhibitors shows benefit for ankylosing spondylitis


Lianne S Gensler

Spinal news international
Therapeutic, Ankylosing spondylitis, NSAIDs, TNF-inhibitors, Prospective study
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