A quick decrease of bone marrow edema in sacroiliac joint could be served as a novel marker for dose tapering of etanercept in ankylosing spondylitis patients
Ruishan Yang, Hongda Liu, Mengpo Fan, Ruishan Yang, Hongda Liu, Mengpo Fan
Abstract
The purpose of this study was to investigate the correlation of bone marrow edema (BME) in sacroiliac joint (SIJ) with clinical characteristics and clinical response, and whether the quick decrease of BME could be served as a novel marker for dose tapering of etanercept in ankylosing spondylitis (AS) patients.Ninety active AS patients underwent etanercept treatment for 6 months were enrolled consecutively and classified into standard dose group (n = 37) and dose tapering group (n = 53). BME in SIJ and clinical response were assessed by SPARCC criteria and ASAS 40 response criteria, respectively. "Quick decrease of BME in SIJ" was defined as the decrease of SPARCC score≥50% from M0 to M1.BME in SIJ was positively correlated with pain VAS score, BASDAI score, CRP, IL-1β, IL-17, and TNF-α levels. ASAS 40 response rate at M6 was lower in dose tapering group than standard dose group, while higher in patients with a quick decrease of BME in SIJ than other patients. Besides, the ASAS 40 response rate in dose tapering group was similar to standard dose group in patients with a quick decrease of BME in SIJ but was lower than standard dose group in patients without a quick decrease of BME in SIJ at M6.A quick decrease of BME in SIJ predicts better treatment response to etanercept, and it might be served as a novel marker for dose tapering initiation of etanercept in AS patients.
Conflict of interest statement
The authors have no funding and conflicts of interest to disclose.
Figures
References
- Mohammadi H, Hemmatzadeh M, Babaie F, et al. MicroRNA implications in the etiopathogenesis of ankylosing spondylitis. J Cell Physiol 2018;5564–73.
- Rezaiemanesh A, Abdolmaleki M, Abdolmohammadi K, et al. Immune cells involved in the pathogenesis of ankylosing spondylitis. Biomed Pharmacother 2018;100:198–204.
- Taurog JD, Chhabra A, Colbert RA. Ankylosing spondylitis and axial spondyloarthritis. N Engl J Med 2016;374:2563–74.
- Damjanov N, Shehhi WA, Huang F, et al. Assessment of clinical efficacy and safety in a randomized double-blind study of etanercept and sulfasalazine in patients with ankylosing spondylitis from Eastern/Central Europe, Latin America, and Asia. Rheumatol Int 2016;36:643–51.
- Ho H-H, Chen J-Y. Ankylosing spondylitis: Chinese perspective, clinical phenotypes, and associated extra-articular systemic features. Curr Rheumatol Rep 2013;15:344.
- Navarro-Sarabia F, Fernandez-Sueiro JL, Torre-Alonso JC, et al. High-dose etanercept in ankylosing spondylitis: results of a 12-week randomized, double blind, controlled multicentre study (LOADET study). Rheumatology 2011;50:1828–37.
- Braun J, Sieper J. Ankylosing spondylitis. Lancet 2007;369:1379–90.
- Lee JH, Youn JI, Kim TY, et al. A multicenter, randomized, open-label pilot trial assessing the efficacy and safety of etanercept 50 mg twice weekly followed by etanercept 25 mg twice weekly, the combination of etanercept 25 mg twice weekly and acitretin, and acitretin alone in patients with moderate to severe psoriasis. BMC Dermatol 2016;16:11.
- Ruwaard J, l’Ami MJ, Marsman AF, et al. Comparison of drug survival and clinical outcome in patients with ankylosing spondylitis treated with etanercept or adalimumab. Scand J Rheumatol 2018;47:122–6.
- Braun J, McHugh N, Singh A, et al. Improvement in patient-reported outcomes for patients with ankylosing spondylitis treated with etanercept 50 mg once-weekly and 25 mg twice-weekly. Rheumatology 2007;46:999–1004.
- Park JW, Yoon YI, Chang SH, et al. THU0211 low dose etanercept treatment for maintenance of clinical remission in ankylosing spondylitis: retrospective cohort study. Ann Rheum Dis 2015;74suppl 2:272.
- Navarro-Compan V, Moreira V, Ariza-Ariza R, et al. Low doses of etanercept can be effective in ankylosing spondylitis patients who achieve remission of the disease. Clinical Rheumatol 2011;30:993–6.
- Moghimi J, Sheikhvatan M, Semnani V. The use of low-dose etanercept as an alternative therapy for treatment of ankylosing spondylitis: a case series. Rheumatol Int 2012;32:2271–4.
- Li J, Wang X, Han Z, et al. Dose reduction of recombinant human tumor necrosis factor inhibitors (etanercept) can be effective in ankylosing spondylitis patients with synovitis of the hip in a Chinese population. Int J Immunopathol Pharmacol 2016;29:510–5.
- Lee SH, Lee YA, Hong SJ, et al. Etanercept 25 mg/week is effective enough to maintain remission for ankylosing spondylitis among Korean patients. Clin Rheumatol 2008;27:179–81.
- Lee J, Noh J-W, Hwang JW, et al. Extended dosing of etanercept 25 mg can be effective in patients with ankylosing spondylitis: a retrospective analysis. Clin Rheumatol 2010;29:1149–54.
- Yates M, Hamilton LE, Elender F, et al. Is etanercept 25 mg once weekly as effective as 50 mg at maintaining response in patients with ankylosing spondylitis? a randomized control trial. J Rheumatol 2015;42:1177–85.
- De Stefano R, Frati E, De Quattro D, et al. Low doses of etanercept can be effective to maintain remission in ankylosing spondylitis patients. Clin Rheumatol 2014;33:707–11.
- Narváez JA, Narváez J, de Albert M, et al. Bone marrow edema in the cervical spine of symptomatic rheumatoid arthritis patients. Semin Arthritis Rheum 2009;38:281–8.
- Manara M, Varenna M. A clinical overview of bone marrow edema. Reumatismo 2014;66:184–96.
- Bennett AN, Marzo-Ortega H, Rehman A, et al. The evidence for whole-spine MRI in the assessment of axial spondyloarthropathy. Rheumatology 2010;49:426–32.
- Rudwaleit M, Schwarzlose S, Hilgert ES, et al. MRI in predicting a major clinical response to anti-tumour necrosis factor treatment in ankylosing spondylitis. Ann Rheum Dis 2007;67:1276–81.
- Kwiatkowska B. Significance of bone marrow edema in pathogenesis of rheumatoid arthritis. Pol J Radiol 2013;78:57–63.
- Schett G. Bone marrow edema. Ann N Y Acad Sci 2009;1154:35–40.
- Rudwaleit M, van der Heijde D, Landewé R, et al. The development of assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis 2009;68:777.
- Qin J, Zhu J, Zhang Y, et al. DWI and SPARCC scoring assess curative effect of early ankylosing spondylitis. Open Med 2016;11:52–8.
- van der Heijde D, Dougados M, Davis J, et al. Assessment in Ankylosing Spondylitis International Working Group/Spondylitis Association of America recommendations for conducting clinical trials in ankylosing spondylitis. Arthritis Rheum 2005;52:386–94.
- Bennett AN, McGonagle D, O’Connor P, et al. Severity of baseline magnetic resonance imaging-evident sacroiliitis and HLA-B27 status in early inflammatory back pain predict radiographically evident ankylosing spondylitis at eight years. Arthritis Rheum 2008;58:3413–8.
- Berthelot JM, Varin S, Cormier G, et al. 25 mg etanercept once weekly in rheumatoid arthritis and spondylarthropathy. Joint, bone, spine: revue du rhumatisme 2007;74:144–7.
- Senabre-Gallego JM, Santos-Ramirez C, Santos-Soler G, et al. Long-term safety and efficacy of etanercept in the treatment of ankylosing spondylitis. Patient Prefer Adherence 2013;7:961–72.
- Cantini F, Niccoli L, Cassara E, et al. Duration of remission after halving of the etanercept dose in patients with ankylosing spondylitis: a randomized, prospective, long-term, follow-up study. Biologics 2013;7:1–6.
- Borras-Blasco J, Gracia-Perez A, Rosique-Robles JD, et al. Clinical and economic impact of the use of etanercept 25 mg once weekly in rheumatoid arthritis, psoriatic arthropathy and ankylosing spondylitis patients. Expert Opin Biol Ther 2014;14:145–50.
- Pedersen MB, Hamilton-Dutoit SJ, Bendix K, et al. DUSP22 and TP63 rearrangements predict outcome of ALK-negative anaplastic large cell lymphoma: a Danish cohort study. Blood 2017;130:554–7.
Source: PubMed