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NSAIDs and TNFi Combo Best for Ankylosing Spondylitis

Ankylosing spondylitis symptoms respond best to high dosages of NSAIDs plus TNFi therapies.

While past studies have looked at the radiographic progression of ankylosing spondylitis after treatment with non-steroidal anti-inflammatory drugs and/or tumor necrosis factor inhibitors, no research has studied the longitudinal relationship between these treatments in ankylosing spondylitis patients, according to Lianne S. Gensler. Gensler of the University of California at San Francisco who will present results from her study on the direct and interactive effects of NSAIDs and TNFi, on Nov. 14 at the American College of Rheumatology annual meeting.

The prospective study included 527 patients (75.7% male) meeting the modified New York criteria. They were followed for at least two years clinically and radiologically (the mean follow time was 2.5 years). Researchers defined progression longitudinally, with a two or higher modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) unit increase in 24 months. They censored patients with high mSASSS scores when they weren’t able to meet the progression definition during the next follow-up period, in order to avoid ceiling effects. The patients’ baseline median mSASSS was 5.36.

In the study, 78% of patients used NSAIDs, while 58.4% used TNFi. From the 1,413 visits analyzed, NSAID indexes were:  zero (38%), greater than zero but less than 50 (29%), and greater than 50 (23%). The multivariable results showed significant interaction between NSAIDs and TNFi, which researchers said indicated lower progression only for patients using TNFi and high dose NSAID (index greater than 50).

They concluded that ankylosing spondylitis patients using both TNFi and NSAIDs experienced a synergic effect in slowing radiographic progression of ankylosing spondylitis, but with the greatest impact from those using high dose NSAIDs plus TNFi.



Dr. Gensler has ties with Janssen, Novartis, Amgen, UCB and AbbVie. Her co-authors have no disclosures.



Lianne S. Gensler. "High Dose Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) and Tumor Necrosis Factor Inhibitor Use Results in Less Radiographic Progression in Ankylosing Spondylitis – a Longitudinal Analysis," Abstract number 1956. 11:15 a.m., Nov. 14, 2016. ACR/ARHP 2016 Annual Meeting.