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Observational Study
. 2018 Apr 24;13(4):e0196281.
doi: 10.1371/journal.pone.0196281. eCollection 2018.

Ankylosing spondylitis disease activity score is related to NSAID use, especially in patients treated with TNF-α inhibitors

Marlies J G Carbo  1 , Anneke Spoorenberg  1   2 , Fiona Maas  1 , Elisabeth Brouwer  1 , Reinhard Bos  2 , Hendrika Bootsma  1 , Eveline van der Veer  3 , Freke Wink  2 , Suzanne Arends  1   2
Affiliations
Observational Study

Ankylosing spondylitis disease activity score is related to NSAID use, especially in patients treated with TNF-α inhibitors

Marlies J G Carbo et al. PLoS One. .

Abstract

Background: Non-steroidal anti-inflammatory drugs (NSAIDs) are regarded as the cornerstone of conventional treatment for AS. However little is known about concomitant NSAID use during treatment (with TNF-α inhibitors) in daily clinical practice.

Methods and findings: Consecutive patients from the GLAS cohort were included. NSAID use and ASAS-NSAID index were evaluated at group level and at individual patient level during 52 weeks of follow-up. Analyses were stratified for treatment regimen. Generalized estimating equations (GEE) was used to evaluate NSAID use in relation to assessments of disease activity over time. In patients starting TNF-α inhibitors (n = 254), 79% used NSAIDs at baseline and this proportion decreased significantly to 38% at 52 weeks. ASAS-NSAID index also decreased significantly from median 65 to 0. In patients on conventional treatment (n = 139), 74% used NSAIDs at baseline with median ASAS-NSAID index of 50 and this remained stable during follow-up. At each follow-up visit, approximately half of the patients changed their type or dose of NSAIDs. GEE analysis over time showed that NSAID use was associated with AS disease activity score (p<0.05). This relation was more pronounced in patients treated with TNF-α inhibitors compared to conventional treatment (B = 0.825 vs. B = 0.250).

Conclusions: In this observational cohort of established AS patients, there was no difference in baseline NSAID use between patients with and without indication for TNF-α inhibitors. NSAID use decreased significantly after starting TNF-α inhibitors. During conventional treatment, NSAID use remained stable at group level. However, NSAID use changed frequently at individual patient level and was significantly associated with disease activity.

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Conflict of interest statement

Competing Interests: The authors have the following interests: MJG Carbo: None declared; Spoorenberg: Grant/research support from Abbvie, Pfizer, UCB, consultant for Abbvie, Pfizer, MSD, UCB, and Novartis; F. Maas: none declared; E. Brouwer: Grant/research support from Pfizer; R. Bos: Grant/research support from Abbvie, Pfizer, consultant for Pfizer and BMS; H. Bootsma: None declared; E van der Veer: None declared; F.R. Wink: consultant for Abbvie; S. Arends: Grant/research support from Pfizer. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Flowchart of inclusion.
Fig 2
Fig 2. Disease activity over time in AS patients.
ASDAS over time in patients starting TNF-α inhibitors (A) and receiving conventional treatment (B); BASDAI over time in patients starting TNF-α inhibitors (C) and receiving conventional treatment (D); CRP over time in patients starting TNF-α inhibitors (E) and receiving conventional treatment (F). *p<0.05 compared to baseline. Box-and-whisker plots: boxes indicate medians with interquartile ranges; + indicate means; whiskers indicate 5–95 percentile; • indicate outliers.
See this image and copyright information in PMC

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