title: Brief Report: Nonsteroidal Antiinflammatory Drug-Sparing Effect of Tumor Necrosis Factor Inhibitors in Early Axial Spondyloarthritis: Results From the DESIR Cohort.
abstract: OBJECTIVE
  To evaluate the effect of tumor necrosis factor (TNF) inhibitors on nonsteroidal antiinflammatory drug (NSAID) intake in a cohort of patients with early axial spondyloarthritis (SpA) over the first 2 years of followup.
  
  
  METHODS
  The Devenir des Spondylarthropathies Indifférenciées Récentes (DESIR) cohort is a prospective, multicenter, observational study cohort of patients with early inflammatory back pain. The management and treatment of these patients were decided by their treating rheumatologists. Data regarding NSAID intake (yes/no) and the Assessment of SpondyloArthritis international Society NSAID score were collected at each visit over 2 years of followup. Patients receiving a TNF inhibitor were matched with those receiving usual care, based on a propensity score. The NSAID-sparing effect of TNF inhibitors was estimated by comparing the percentage of patients reaching several end points (e.g., a decrease in the NSAID score to <10 over 2 years) and by modeling NSAID intake using mixed models.
  
  
  RESULTS
  Among the 627 patients who were followed up, 181 (28.9%) received a TNF inhibitor, and these patients were matched to 181 patients who received usual care. The baseline characteristics of the patients in the 2 groups were comparable (∼40% of the patients were male, and the mean age was 34 years). Initially, 90.2% of patients receiving TNF inhibitors and 90.0% of those receiving usual care had been treated with NSAIDs during the previous 6 months. The number of patients who received an NSAID decreased over time in both groups, but the decrease was greater in the group receiving TNF inhibitors (P = 0.04). The decrease in the median NSAID score was significantly greater in the TNF inhibitor group (54.9 versus 41.9), and the percentage of patients in whom the NSAID score decreased by >50% or to <10 or in whom NSAID treatment was discontinued was greater in the TNF inhibitor group (67.6% versus 46.2%).
  
  
  CONCLUSIONS
  Treatment with TNF inhibitors was associated with a decrease in the proportion of patients taking NSAIDs and with a rapid and sustained decrease in NSAID intake. This study is the first to confirm the NSAID-sparing effect of TNF inhibitors in patients with early axial SpA in a real-life clinical setting.
authors.affiliation: Anna Moltó, MD, PhD: Université Pierre et Marie Curie, GRC-UPMC 08, Hôpital Pitié-Salpêtrière, AP-HP, Université Paris Descartes, Hôpital Cochin, AP-HP, INSERM U1153, and PRES Sorbonne Paris-Cité, Paris, France.
authors.forename: Anna
authors.initials: A
authors.lastname: Moltó
authors.affiliation: Université Pierre et Marie Curie and Hôpital Pitié-Salpêtrière, AP-HP, Paris, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Granger
authors.affiliation: Université de Franche-Comté and Centre Hospitalier Régional Universitaire de Besançon, Besançon, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Wendling
authors.affiliation: Université de Versailles St. Quentin en Yvelines and Hôpital Ambroise Paré, AP-HP, Boulogne-Billancourt, France.
authors.forename: Maxime
authors.initials: M
authors.lastname: Breban
authors.affiliation: Université Paris Descartes, Hôpital Cochin, AP-HP, INSERM U1153, and PRES Sorbonne Paris-Cité, Paris, France.
authors.forename: Maxime
authors.initials: M
authors.lastname: Dougados
authors.affiliation: Université Pierre et Marie Curie, GRC-UPMC 08, and Pitié-Salpêtrière Hospital, AP-HP, Paris, France.
authors.forename: Laure
authors.initials: L
authors.lastname: Gossec
mesh_terms: D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D057216:Propensity Score; D011446:Prospective Studies; D058566:Sacroiliitis / Q000188:drug therapy*; D025242:Spondylarthropathies / Q000188:drug therapy*; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha