Ioannis Parodis, MD


August 10, 2015

In This Article

Ankylosing Spondylitis: Updates on Prognosis and Treatment

In the field of spondyloarthritis, Machado and colleagues[13] add to our knowledge of syndesmophyte formation, which remains poorly understood. They demonstrated that MRI-detected inflammation and fat deposition both contributed to syndesmophyte formation at the same vertebral edge in patients with AS.

Another standout study was by Pedersen and colleagues,[14] who aimed to determine predictors of sustained clinical remission in patients with AS receiving TNF inhibitors. They found that sustained remission was less likely in smokers, but more likely in patients who attained normalization of C-reactive protein early after treatment initiation.

Baraliakos and colleagues[15] studied the similarities and differences between axial spondyloarthritis and fibromyalgia using different sets of classification criteria. They found that no patients with fibromyalgia fulfilled the Assessment of SpondyloArthritis International Society classification criteria for axial spondyloarthritis, and only a small proportion of patients with axial spondyloarthritis fulfilled one or more of the classification criteria sets for fibromyalgia. Of note, patients with fibromyalgia reported higher pain scores and more functional deficits compared with patients with RA or axial spondyloarthritis.

Because previous studies have shown reduced radiographic progression in patients with AS who were given nonsteroidal anti-inflammatory drugs (NSAIDs) continuously compared with patients given NSAIDs on demand,[16,17] Sieper and colleagues[18] aimed to confirm this effect of NSAIDs in a randomized, prospective, multicenter trial (ENRADAS). Patients with AS were randomly assigned to receive either diclofenac continuously or on demand for 2 years. Switching to another NSAID was possible in the event of poor efficacy or side effects, but TNF inhibitors were not allowed.

This study showed no beneficial effects of continuous vs on-demand use of diclofenac on preventing radiographic progression. Information on whether other NSAIDs could have had a different effect on radiographic progression was impossible to extract from this trial, because 73% of the patients were still on diclofenac at its conclusion.

Another therapeutic advance reported at the meeting was the results of MEASURE 2, a randomized, double-blind, placebo-controlled, phase 3 trial of subcutaneously administered secukinumab in patients with AS.[19] Secukinumab 150 mg provided sustained improvements in signs and symptoms of AS, including reduced inflammation and improved physical function and health-related quality of life 52 weeks after treatment initiation. The drug was well tolerated and demonstrated an acceptable safety profile.


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