Association between resolution of MRI-detected inflammation and improved clinical outcomes in axial spondyloarthritis under long-term anti-TNF therapy.

Judith Rademacher, Murat Torgutalp, Valeria Rios Rodriguez, Joachim Sieper, H Haibel, Fabian Proft, Denis Poddubnyy, Mikhail Protopopov, Kay-Geert Hermann, Christian Althoff

Journal: RMD open 2025;11(1):

PMID: 39762123

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Abstract

OBJECTIVES

In this post-hoc analysis of ESTHER trial, we aimed to investigate the longitudinal relationship between inflammation on MRI and the achievement of inactive disease/low disease activity in patients with axial spondyloarthritis (axSpA) treated with long-term tumor necrosis factor (TNF) inhibitor etanercept.

METHODS

Of the 76 patients with active axSpA in the ESTHER trial, we included all patients treated with etanercept for at least 6 months for main analysis. All clinical and MRI data from 4.5 years of follow-up were used in the analysis. MRIs of the spine and sacroiliac (SI) joints were performed at baseline, week 24, week 48 and yearly thereafter and were evaluated for active inflammatory lesions according to the Berlin MRI score.

RESULTS

Longitudinal analysis showed that higher SI joint osteitis score was associated with higher Axial Spondyloarthritis Disease Activity Score (ASDAS) at the same time point (β=0.08, 95% CI (0.05; 0.11)) and at the next time point 6 months later (β=0.05, 95% CI (0.02; 0.07)). Furthermore, resolution of osteitis in the SI joint (Berlin MRI osteitis score of ≤1) was associated with lower ASDAS at the next time point (β=-0.26, 95% CI (-0.42; -0.09)), higher odds of achieving ASDAS low disease activity (OR=5.61, 95% CI (1.06; 29.67)) and inactive disease status (OR=2.23, 95% CI (1.01; 4.94)) at the next time point.

CONCLUSIONS

The presence of inflammation on SI joints-MRI is associated with higher disease activity in axSpA. Resolution of inflammation on MRI is associated with better clinical outcomes in the long-term follow-up. Thus, achieving complete resolution of inflammation is favourable for meeting the treatment goals in axSpA.

TRIAL REGISTRATION NUMBER

NCT00844142.

Address: Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Gastroenterology, Infectious Diseases and Rheumatology (including Nutrition Medicine), Charite Universitatsmedizin Berlin, Berlin, Germany.; Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Gastroenterology, Infectious Diseases and Rheumatology (including Nutrition Medicine), Charite Universitatsmedizin Berlin, Berlin, Germany.; Berlin Institute of Health at Charite, Berlin, Germany.; Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiology (including Pediatric Radiology), Charité Universitätsmedizin Berlin, Berlin, Germany.; HELIOS Klinikum Emil von Behring GmbH, Berlin, Germany.; Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Gastroenterology, Infectious Diseases and Rheumatology (including Nutrition Medicine), Charite Universitatsmedizin Berlin, Berlin, Germany [email protected].; Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Gastroenterology, Infectious Diseases and Rheumatology (including Nutrition Medicine), Charite Universitatsmedizin Berlin, Berlin, Germany.; Epidemiology Unit, German Rheumatism Research Center Berlin, Berlin, Germany.

DOI: 10.1136/rmdopen-2024-004921

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MeSH Terms: Adult, Female, Humans, Male, Middle Aged, Antirheumatic Agents, Axial Spondyloarthritis, Etanercept, Inflammation, Longitudinal Studies, Magnetic Resonance Imaging, Osteitis, Sacroiliac Joint, Severity of Illness Index, Treatment Outcome, Tumor Necrosis Factor Inhibitors, Tumor Necrosis Factor-alpha, Clinical Trials, Phase II as Topic, Randomized Controlled Trials as Topic