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Published in: Clinical Rheumatology 3/2024

29-12-2023 | Spondyloarthropathy | ORIGINAL ARTICLE

Effects of disease-modifying anti-rheumatic drugs on sacroiliac MRI score in axial spondyloarthritis: a systematic review and meta-analysis

Authors: Aude Hansmaennel, Olivier Fakih, Aurélie Gerazime, Clément Prati, Mickaël Chouk, Daniel Wendling, Frank Verhoeven

Published in: Clinical Rheumatology | Issue 3/2024

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Abstract

Introduction

Sacroiliac bone marrow edema is an important factor in the diagnosis and management of axial spondyloarthritis (axSpA). The aim of this meta-analysis is to assess the effect of the different bDMARDs and tsDMARDs on the SPARCC score at 12–16 and 48–52 weeks.

Methods

A systematic review, performed on PubMed (including Medline), Cochrane (CENTRAL) and DOAJ databases, included randomized controlled studies evaluating the sacroiliac joint (SIJ) SPARCC score at 12–16 or 48–52 weeks in patients with axSpA meeting the ASAS 2009 criteria or the modified New York criteria. We included studies evaluating the effects of the different treatments on the SPARCC score of SIJ in axial spondyloarthritis in comparison to a control group.

Results

Eighteen studies were included in the meta-analysis. Nine studies evaluated the effect of TNFα inhibitors (TNFi), three for IL-17 inhibitors, and four for JAK inhibitors. At 12 and 16 weeks, SIJ SPARCC score was significantly improved by TNFi (WMD: − 3.29 [95% CI − 4.25; − 2, 34]), by IL-17 inhibitors (WMD: − 4.66 [95% CI − 6.22; − 3.09]), and by JAK inhibitors (JAKi) (WMD: − 3.06 [95% CI − 3.24; − 2.89]). There was no difference between the molecule subgroups. At 48–52 weeks, TNFα inhibitors reduced more SIJ SPARCC, but not significantly (WMD: − 2.26 [95% CI − 4.94; 0.42]), than placebo groups who began a TNFi treatment with delay.

Conclusion

Our meta-analysis shows a comparable improvement of the SIJ SPARCC score regarding TNFi, JAKi, and IL-17 inhibitors at three months and suggests the presence of an opportunity window.
Key Points
Anti-TNF Ab, anti-IL17 Ab, and JAK inhibitor treatments reduce the sacroiliac joint SPARCC scores.
There is no difference between the different treatments in the reduction of the sacroiliac joint SPARCC score after 3 months in axial spondyloarthritis.
Appendix
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Metadata
Title
Effects of disease-modifying anti-rheumatic drugs on sacroiliac MRI score in axial spondyloarthritis: a systematic review and meta-analysis
Authors
Aude Hansmaennel
Olivier Fakih
Aurélie Gerazime
Clément Prati
Mickaël Chouk
Daniel Wendling
Frank Verhoeven
Publication date
29-12-2023
Publisher
Springer International Publishing
Published in
Clinical Rheumatology / Issue 3/2024
Print ISSN: 0770-3198
Electronic ISSN: 1434-9949
DOI
https://doi.org/10.1007/s10067-023-06849-5

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