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. 2020 Nov 28:12:1759720X20975912.
doi: 10.1177/1759720X20975912. eCollection 2020.

Conventional disease-modifying antirheumatic drugs therapy may not slow spinal radiographic progression in ankylosing spondylitis: results from an 18-year longitudinal dataset

Tae-Han Lee  1 , Bon San Koo  2 , Bora Nam  1 , Ji Seon Oh  3 , Seo Young Park  4 , Seunghun Lee  5 , Kyung Bin Joo  5 , Tae-Hwan Kim  6
Affiliations

Conventional disease-modifying antirheumatic drugs therapy may not slow spinal radiographic progression in ankylosing spondylitis: results from an 18-year longitudinal dataset

Tae-Han Lee et al. Ther Adv Musculoskelet Dis. .

Abstract

Objectives: The clinical benefit of conventional disease-modifying antirheumatic drugs (cDMARDs) for treating ankylosing spondylitis (AS) is generally limited to improvements in peripheral arthritis. However, cDMARDs could be conditionally considered as alternatives to established drugs for improving axial manifestations in exceptional circumstances. However, there are few studies of the impact of cDMARDs on radiographic progression outcomes. Therefore, we investigated the effectiveness of cDMARDs on radiographic progression in AS.

Methods: Among 1280 AS patients at a single hospital from 2000 to 2018, 301 who had been treated with sulfasalazine (SSZ) or methotrexate (MTX) were enrolled. For each patient, the entire follow-up period was split into 1-year intervals. Each interval was classified as either an "on-cDMARD" interval, which was a period of treatment with SSZ alone, MTX alone, or a combination of SSZ and MTX, or an "off-cDMARD" interval, which was a period without cDMARD treatment. Radiographic progression was scored using the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS). The relationship between cDMARD use and radiographic progression within the intervals, defined as the rate of mSASSS progression, was investigated using linear models with adjustment for potential confounding covariates and for clustering among observations from the same patient.

Results: The 732 on-cDMARD intervals and 1027 off-cDMARD intervals were obtained from enrolled patients. In multivariable regression analysis, there was no significant association between cDMARDs and the rate of mSASSS progression (β = -0.081, p = 0.418). The mean adjusted mSASSS change per year was 0.610 from on-cDMARD intervals and 0.691 from off-cDMARD intervals.

Conclusion: Treatment with cDMARDs may not reduce radiographic progression in AS patients.

Keywords: ankylosing spondylitis; disease-modifying antirheumatic drugs; methotrexate; radiographic progression; sulfasalazine.

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Conflict of interest statement

Conflict of interest statement: The authors declare that there is no conflict of interest.

Figures

Figure 1.
Figure 1.
Definition of on-cDMARD intervals and off-cDMARD intervals. The mSASSS values at the beginning and end points in each interval were imputed with a linear interpolation method using the values measured before and after each time point. cDMARD, conventional disease-modifying antirheumatic drug; mSASSS, modified Stoke Ankylosing Spondylitis Spine Score.
Figure 2.
Figure 2.
Flowchart of creating time intervals for each of the patients. cDMARDs, conventional disease-modifying antirheumatic drugs.
See this image and copyright information in PMC

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