Combination Therapy of TNF Inhibitors and NSAIDs May Help Slow Down Radiographic Progression in Ankylosing Spondylitis

By Spondylitis Association of America

Tuesday, April 30, 2019

According to findings from a recent cohort study, the combined use of nonsteroidal anti-inflammatory drugs (NSAIDs) and tumor necrosis factor (TNF) inhibitors, may help slow the progression of damage to the spine in ankylosing spondylitis, mitigating some of the effects of the disease.

The four-year study officially called, “Combined effects of tumor necrosis factor inhibitors and NSAIDs on radiographic progression in ankylosing spondylitis,” included 519 patients with ankylosing spondylitis, with 75 percent being male, an average age of 41.4 years, and average disease duration of 16.8 years.

Researchers used the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS), which uses a scoring system to evaluate radiographic damage in AS. Clinical and medication data were collected every 6 months and radiographs were taken at the start of the study and every 2 years after that. Scores were documented throughout the study to track disease progression, with a lower score indicating less radiographic progression and damage. Researchers compared scores from two groups: TNF Inhibitor users and those who took both TNF Inhibitors and NSAIDS. The scores for the two groups were significantly different. The patients taking only TNF inhibitors scored 16.12 while those taking TNF inhibitors plus low-or high-dose of NSAIDs, scored 15.52 and 14.17 respectively.  

“Our results suggest that the use of TNF inhibitors and NSAIDs, particularly celecoxib [Celebrex], have a synergistic effect to slow radiographic progression in ankylosing spondylitis patients, particularly at higher doses,” said lead study author Dr. Lianne S. Gensler, who is also a long standing member of the Medical and Scientific Advisory Board (MSAB) of the Spondylitis Association of America.

Editor’s note: Look for an in-depth article exploring this important study by lead study author, and SAA MSAB member, Lianne Gensler, MD in an upcoming issue of our magazine, Spondylitis Plus.



Gensler L, Gianfrancesco M, Weisman M, et al OP0198 Combined effects of tumour necrosis factor inhibitors and nsaids on radiographic progression in ankylosing spondylitis Annals of the Rheumatic Diseases 2018;77:148.

Melao, A. (2018, June 27). #EULAR2018 – Study Examines Combo of TNF Inhibitors, NSAIDs in AS. Retrieved April 26, 2019, from


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