OBJECTIVE To investigate the effect of therapies on radiographic progression in patients with axial spondyloarthritis (SpA). METHODS A comprehensive database search for studies assessing radiographic progression in axial SpA (particular treatment versus no treatment of interest) was performed. Study-specific standardized mean differences in treatment outcomes at 2 and ≥4 years were estimated and combined using random-effects models. RESULTS Twenty-four studies in patients with axial SpA were identified, of which 18 involved tumor necrosis factor inhibitors (TNFi), 8 involved nonsteroidal antiinflammatory drugs (NSAIDs), and 1 involved secukinumab. Spinal radiographic progression, as measured by the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS), was not significantly different between TNFi-treated and biologics-naive patients at 2 years (mSASSS difference -0.73 [95% confidence interval (95% CI) -1.52, 0.12], I2 = 28%) and ≥4 years (mSASSS difference -2.03 [95% CI -4.63, 0.72], I2 = 63%). Sensitivity analyses restricted to studies with a low risk of bias showed a significant difference in spinal radiographic progression between TNFi-treated and biologics-naive patients at ≥4 years (mSASSS difference -2.17 [95% CI -4.19, -0.15]). No significant difference in spinal radiographic progression was observed between NSAID-treated and control patients (mSASSS difference -0.30 [95% CI -2.62, 1.31], I2 = 71%) or between secukinumab-treated and biologics-naive patients (mSASSS difference -0.34 [95% CI -0.85, 0.17]). With regard to treatment differences in patients with nonradiographic axial SpA or in patients with radiographic progression measured using the sacroiliac joint score, an insufficient number of studies were available for analysis. CONCLUSION Although no significant protective effect of TNFi treatment on spinal radiographic progression was seen over the course of 2 years or ≥4 years in patients with axial SpA, our analysis restricted to studies with a low risk of bias showed a protective effect of TNFi after ≥4 years. Therefore, long-term TNFi exposure might confer beneficial effects on spinal radiographic progression in axial SpA. No difference in radiographic progression at 2 years was seen in either the NSAID or secukinumab treatment groups compared to their controls. Future studies should explore the effects of biologic treatment on radiographic progression, as well as the effects of long-term biologics exposure, in patients with early axial SpA or those with nonradiographic axial SpA.

中文翻译：

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治疗对中轴型脊柱关节炎放射学进展的影响：系统评价和荟萃分析。

目的 探讨治疗对中轴型脊柱关节炎 (SpA) 患者影像学进展的影响。方法 对评估中轴 SpA 放射学进展（特定治疗与无感兴趣治疗）的研究进行了全面的数据库搜索。使用随机效应模型估计并结合研究特定的 2 年和 4 年以上治疗结果的标准化平均差异。结果 共确定了 24 项针对中轴 SpA 患者的研究，其中 18 项涉及肿瘤坏死因子抑制剂 (TNFi)，8 项涉及非甾体抗炎药 (NSAID)，1 项涉及苏金单抗。根据改良斯托克强直性脊柱炎脊柱评分 (mSASSS) 测量，2 年时接受 TNFi 治疗的患者与未接受生物制剂治疗的患者之间的脊柱放射学进展没有显着差异（mSASSS 差异 -0.73 [95% 置信区间 (95% CI) - 1.52, 0.12]，I2 = 28%）且≥4 年（mSASSS 差异 -2.03 [95% CI -4.63, 0.72]，I2 = 63%）。仅限于低偏倚风险研究的敏感性分析显示，≥4 年时接受 TNFi 治疗的患者与未接受生物制剂治疗的患者之间的脊柱放射学进展存在显着差异（mSASSS 差异 -2.17 [95% CI -4.19，-0.15]）。NSAID 治疗组和对照患者之间（mSASSS 差异 -0.30 [95% CI -2.62, 1.31]，I2 = 71%）或苏金单抗治疗组和未使用生物制剂的患者之间（mSASSS 差异 - 0.34 [95% CI -0.85, 0.17]）。关于非放射学中轴​​型 SpA 患者或使用骶髂关节评分测量放射学进展患者的治疗差异，可供分析的研究数量不足。结论 虽然 TNFi 治疗对中轴性 SpA 患者在 2 年或≥4 年的脊柱影像学进展中没有显着的保护作用，但我们的分析仅限于低偏倚风险的研究，表明 TNFi 在 ≥ 4 年之后具有保护作用。 4年。因此，长期暴露于 TNFi 可能对中轴型 SpA 的脊柱放射学进展产生有益影响。与对照组相比，NSAID 或苏金单抗治疗组在 2 年时的影像学进展没有差异。未来的研究应探讨生物制剂治疗对早期中轴型 SpA 或非放射学中轴​​型 SpA 患者的放射学进展的影响，以及长期生物制剂暴露的影响。