To review the effect of tumor necrosis factor‐alpha inhibitor (TNFi) therapies on radiographic progression in ankylosing spondylitis (AS) patients as evaluated by the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). Pubmed, MEDLINE, EMBASE, and the Cochrane Library databases were searched from inception to August 2019. All comparative and non‐comparative studies that evaluated the clinical effectiveness of TNFi on radiographic progression as assessed by mSASSS change at a minimum follow‐up of 1 year were included. The Newcastle–Ottawa Scale and Cochrane Collaboration Risk of Bias Tool were utilized to assess the methodological quality. Pooled analysis was performed for continuous and binomial variables where appropriate. Inter‐rater reliability of mSASSS status and change scores were assessed with intra‐class coefficients (ICC). Twenty‐one studies were identified with a total of 4460 patients (mean age: 40.4 years [range 25.3‐50 years]; 76% male; mean baseline mSASSS: 12.7 units [range 5.5‐19.8 units]). All studies (3 randomized and 18 observational studies) were considered to have moderate‐to‐high methodological quality. The inter‐rater reliability of mSASSS status and change scores from 14 of the 21 studies were excellent (ICC ranges, 0.91‐0.99) and moderate‐to‐excellent (ICC ranges, 0.58‐0.90), respectively. From the 21 studies, 11/21 (50%) demonstrated a delayed effect in mSASSS in AS patient administered TNFi. When stratifying these studies into those with ≤4 years of follow‐up and >4 years follow‐up, 3/11 (27%) and 8/10 (80%) studies respectively indicated a delayed effect of mSASSS with TNFi in AS patients. Pooling for meta‐analysis from 3 studies (1159 patients) with study durations ranging 4‐8 years, indicated that TNFi‐treated patients had reduced odds of structural progression (odds ratio 0.81; 95% CI 0.68‐0.96; P  = .01; I ² = 0%). Mean rate of mSASSS change from 16 studies ranged from −0.15 to 7.3 mSASSS units for all AS patients. Meta‐analysis indicated a numerical, but statistically non‐significant, reduction in the rate of mSASSS change with TNFi treatment (7 studies [1438 patients]; mean difference, −0.24; 95% CI, −0.49‐0.01; P  = .06; I ² = 0%). This systematic review and meta‐analysis indicated that >4 years of TNFi usage was associated with delayed structural progression by mSASSS. The narrative analysis of the data from 21 studies further confirmed that studies with >4 years of follow‐up had delayed structural progression with TNFi use in AS patients. The systematic review also confirmed that mSASSS has good‐to‐excellent inter‐rater reliability in AS.

中文翻译：

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TNF抑制剂治疗对强直性脊柱炎患者脊柱结构进展的影响：系统评价和荟萃分析。

回顾斯托克强直性脊柱炎脊柱评分（mSASSS）评估的肿瘤坏死因子-α抑制剂（TNFi）治疗对强直性脊柱炎（AS）患者放射学进展的影响。从开始到2019年8月，搜索Pubmed，MEDLINE，EMBASE和Cochrane库数据库。所有比较和非比较研究均通过了至少1年的mSASSS变化评估，评估了TNFi对放射学进展的临床有效性。被包括在内。纽卡斯尔-渥太华量表和Cochrane偏倚风险协作工具用于评估方法学质量。适当时对连续变量和二项式变量进行汇总分析。使用类内系数（ICC）评估mSASSS状态的评估者间可靠性和变更得分。共鉴定出21项研究，共4460例患者（平均年龄：40.4岁[范围25.3-50岁]；男性76％；平均mSASSS基线：12.7单位[5.5-19.8单位]）。所有研究（3项随机研究和18项观察性研究）均被认为具有中等至较高的方法学质量。来自21项研究中的14项的mSASSS状态的评估者间可靠性和变化评分分别为极好（ICC范围，0.91-0.99）和中等至优秀（ICC范围，0.58-0.90）。在这21项研究中，有11/21（50％）证实了AS患者给予TNFi后mSASSS的延迟作用。当将这些研究分为随访≤4年和随访≥4年的研究时，分别有3/11（27％）和8/10（80％）研究表明，mSASSS和TNFi对AS患者的延迟作用。P  = 0.01；我²  = 0％）。对于所有AS患者，从16项研究得出的mSASSS平均变化率在-0.15至7.3 mSASSS单位之间。荟萃分析显示，TNFi治疗后mSASSS改变率的数值降低，但在统计学上无统计学意义（7项研究[1438例患者]；平均差异为-0.24； 95％CI为-0.49-0.01；P  = .06 ;我² = 0％）。这项系统的回顾和荟萃分析表明，> 4年的TNFi使用与mSASSS延迟结构进展有关。对来自21项研究的数据的叙述性分析进一步证实，随访时间超过4年的研究在AS患者中使用TNFi延缓了结构进展。系统评价还证实，mSASSS在AS中具有良好的评估者间可靠性。