FRI0282 CONVENTIONAL DISEASE-MODIFYING ANTIRHEUMATIC DRUGS THERAPY HAS NO EFFICACY IN SLOWING SPINAL RADIOGRAPHIC PROGRESSION IN ANKYLOSING SPONDYLITIS: RESULTS FROM 18-YEAR LONGITUDINAL DATA. (2nd June 2020)

• Record Type: Journal Article
• Authors: Lee, T. H.; Koo, B. S.; Lee, S.; Lee, Y. K.; Oh, J. S.; Park, S. Y.; Kim, T. H.
• Is Part Of: Annals of the rheumatic diseases. Volume 79(2020)Supplement 1
• Page Start: 728
• Page End: 729
• Publication Date: 2020-06-02
• Subjects: Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/annrheumdis-2020-eular.3116
• Languages: English
• ISSNs: 0003-4967

Abstract

Abstract : 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. 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