Exploring the effectiveness of various treatments for people with axial spondyloarthritis

axSpA is a chronic inflammatory rheumatic disease that primarily affects the spine and sacroiliac joints. This can cause significant pain and disability. Many different agents are available to treat people with axSpA, but they don’t always work for everyone.

Previously, pooled data from randomized controlled trials demonstrated reduced efficacy of tumor necrosis factor (TNFi) inhibitor treatment in women compared to men with ankylosing spondylitis

Dr. Pasoon Hellamand and colleagues sought to validate previous studies using data from a large multinational cohort based on actual clinical practice. A total of 6,451 axSpA patients were evaluated for treatment response. Analysis of the results showed that the probability for women to have a clinically important improvement was 15% lower than for men. Additionally, TNFi retention rates were significantly lower in females. Recognizing these gender differences is relevant to personalized patient care and can improve patient education.

Another group working on axSpA investigated whether NSAID treatment was associated with delayed radiographic progression of the spine. To date, there have been conflicting reports: a previous analysis by GESPIC – the original German SPondyloarthritis cohort – showed that higher intake of NSAIDs can delay new bone formation in radiographic axSpA. However, it was unclear whether selective cyclooxygenase-2 (COX2i) inhibitors might have a stronger effect than non-selective ones, and whether the effect could also be seen in non-radiographic disease.

Dr. Murat Torgutalp’ et al. examined 243 patients with early axSpA from the GESPIC to establish the association between NSAID use and radiographic progression of the spine over 2 years. Overall, the results showed that high NSAID consumption is associated with lower radiographic spinal progression, especially in patients with radiographic axSpA. COX2i might possess a stronger inhibitory effect on radiographic progression compared to non-selective NSAIDs.


European Alliance of Rheumatology Associations, EULAR

Journal references:

  • Hellamand P, et al. Gender differences in the efficacy of first-line tumor necrosis factor inhibitors in axial spondyloarthritis; results from fifteen countries of the EuroSpA research collaboration network. Presented at EULAR 2022; summary OP0020.
  • Torgutalp M, et al. Treatment with nonsteroidal anti-inflammatory drugs is associated with delayed radiographic progression of the spine in patients with axial spondyloarthritis. Presented at EULAR 2022; summary OP0021.

Sara H. Byrd