title: Radiographic progression in patients with ankylosing spondylitis according to tumor necrosis factor blocker exposure: Observation Study of Korean Spondyloarthropathy Registry (OSKAR) data.
abstract: OBJECTIVE
  To evaluate the influence of tumor necrosis factor (TNF) blocker on the radiographic progression in ankylosing spondylitis (AS) patients.
  
  
  METHODS
  A total of 610 patients were recruited. We stratified two groups (TNF blocker naïve and exposure patients). After then, we analyzed the radiographic spinal progression. Univariable and multivariable analyses were performed to identify predictors associated with radiographic progression, which was assessed by the modified Stokes AS Spinal Score (mSASSS). As this was an observational study, the patients were not randomized to the treatment arm. Therefore, propensity score matching was also done with age, gender, and the baseline CRP. The generalized estimating equation model was performed in the post-matched samples. Potential confounders were included in the model.
  
  
  RESULTS
  Agreements between the two readers were excellent. Of the 610 patients with AS, 341 patients did not have any exposure to TNF blocker. The radiographic progression (mean±SEM) was not significantly different between groups (4.73±1.01, and 6.14±2.00, P=0.54) in spite of adjusting for confounding factors (age, gender, disease duration, smoking, CRP level, NSAID intake, and baseline mSASSS). Propensity score matching was done to confirm the effect of TNF blockers on radiographic progression. Even after adjusting for the TNF blocker exposure, the result still remained not significant with an OR for progression while taking TNF blocker of 0.69 (P=0.41; 95% CI: 0.29-1.63).
  
  
  CONCLUSIONS
  Our registry data showed that TNF blocker failed to affect the radiographic progression over 5 years in AS patients.
authors.affiliation: Department of Rheumatology, Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital, 501-757 Gwangju, Republic of Korea.
authors.forename: Tae-Jong
authors.initials: TJ
authors.lastname: Kim
authors.affiliation: Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, 17 Haengdang-Dong, Sungdong-Gu, 133-792 Seoul, Republic of Korea.
authors.forename: Ji-Hui
authors.initials: JH
authors.lastname: Shin
authors.affiliation: Department of Preventive Medicine, Chonnam National University Medical School, 501-757 Gwangju, Republic of Korea.
authors.forename: Suna
authors.initials: S
authors.lastname: Kim
authors.affiliation: Department of Orthopaedics, Hanyang University Hospital for Rheumatic Diseases, 133-792 Seoul, Republic of Korea.
authors.forename: Il-Hoon
authors.initials: IH
authors.lastname: Sung
authors.affiliation: Department of Radiology, Hanyang University Hospital for Rheumatic Diseases, 133-792 Seoul, Republic of Korea.
authors.forename: Seunghun
authors.initials: S
authors.lastname: Lee
authors.affiliation: Department of Radiology, Hanyang University Hospital for Rheumatic Diseases, 133-792 Seoul, Republic of Korea.
authors.forename: Yoonah
authors.initials: Y
authors.lastname: Song
authors.affiliation: Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, 17 Haengdang-Dong, Sungdong-Gu, 133-792 Seoul, Republic of Korea. Electronic address: thkim@hanyang.ac.kr.
authors.forename: Tae-Hwan
authors.initials: TH
authors.lastname: Kim
mesh_terms: D000328:Adult; D018501:Antirheumatic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012042:Registries; D013131:Spine / Q000000981:diagnostic imaging / Q000187:drug effects; D013167:Spondylitis, Ankylosing / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000503:physiopathology; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha
keywords: Ankylosing spondylitis; Radiographic progression; TNF blocker