A cohort study presented at the Annual European Congress of Rheumatology on June 14 in Amsterdam found that ankylosing spondylitis patients who take tumour necrosis factor (TNF) inhibitors experience the least disease progression when they add nonsteroidal anti-inflammatory drugs (NSAIDs).

“Our results suggest that the use of TNF inhibitors and NSAIDs, particularly celecoxib, have a
synergistic effect to slow radiographic progression in ankylosing spondylitis patients, particularly at higher doses,”said study author Lianne Gensler, of University of California, San Francisco, in a EULAR news release. “This is the first study to compare whether effects are comparable among different NSAIDs in this setting.”

Gensler and colleagues found that the combination of celecoxib and TNF inhibitors worked particularly well both two and four years out.

Many patients tend to discontinue taking nonsteroidal anti-inflammatory drugs when their symptoms are under control, so there had been very limited data on the impact this combined therapy has on radiographic progression. “Radiographic progression has an important bearing on patient mobility, as well as affecting their general well-being and day-to-day living,” said Robert Landewé, EULAR’s scientific program committee chairman.

Among the 519 AS patients in the study, 66 percent used NSAIDs and 46 percent took TNFi. After researchers adjusted the analysis for gender, race, ethnicity, education, symptom duration, enrolment year, and other factors, they found an association between less disease progression and TNFi with the addition of NSAIDs. The greatest reduction came with combined celecoxib and TNFi.