Mortality Among Patients With AS Improved With TNFi Treatment

As a whole, patients with ankylosing spondylitis had increased mortality compared with the general population, but the increase was not seen in patients treated with tumor necrosis factor inhibitors (TNFi), according to a nationwide cohort study published in the journal Arthritis Care & Research.

The retrospective study included 5930 patients diagnosed with ankylosing spondylitis in Israel between 2002 and 2018. Patients were matched by age, sex, clinic, and enrollment time to 29,018 controls from the general population. Among patients in the ankylosing spondylitis cohort, 54.8% were treated only with nonsteroidal anti-inflammatory drugs, 29.7% were treated with TNFi, and 28.4% were treated with disease-modifying antirheumatic drugs (DMARDs).

Over a median 7.5 years of follow-up, 667 patients with ankylosing spondylitis and 2919 controls died, according to the study.

Mortality rates were higher among patients with ankylosing spondylitis compared with controls. Researchers reported an age- and sex-adjusted mortality hazard ratio of 1.19. Mortality hazard ratios were 1.15 for men, 1.32 for women, and 1.14 after adjusting for background comorbidities.

Patients with ankylosing spondylitis treated with TNFi, or with a combination of TNFi and DMARDs, however, did not show excess mortality. Compared with controls, hazard ratios for mortality were 0.67 with TNFi treatment and 0.93 with TNFi combined with DMARDs, the study found.

“Within the ankylosing spondylitis cohort, age, male sex, background comorbidities, and C-reactive protein levels were identified as risk factors for mortality,” researchers reported.

—Jolynn Tumolo

Reference
Ben-Shabat N, Shabat A, Watad A, et al. Mortality in ankylosing spondylitis according to treatment: a nationwide retrospective cohort study of 5,900 patients from Israel. Arthritis Care Res. 2022;74(10):1614-1622. doi:10.1002/acr.24616