Periodontitis Response to Anti-TNF Therapy in Ankylosing Spondylitis.

BACKGROUND: Recently, it has been demonstrated that patients with ankylosing spondylitis (AS) and rheumatoid arthritis (RA) have a higher risk of periodontitis; however, the effect of anti-TNF therapy in periodontal status of patients with AS and particularly in dental attachment is not known. OBJECTIVE: To evaluate longitudinally the local periodontal effect of TNF-antagonist in AS and compare to patients with RA. METHODS: Fifteen patients with AS and 15 RA control patients were prospectively evaluated at baseline and after 6 months (6 M) of anti-TNF therapy. Periodontal assessment included: probing pocket depth (PPD), clinical attachment level (CAL), gingival bleeding index, and plaque index. Rheumatologic clinical and laboratory evaluations were the following: Bath AS Disease Activity Index, Bath AS Metrology Index, Bath AS Functional Index, C-reactive protein and erythrocyte sedimentation rate for AS and Disease Activity Score 28 joints, and C-reactive protein and erythrocyte sedimentation rate for patients with RA. RESULTS: At baseline, periodontal parameters were alike in AS and RA (P > 0.05). After 6 M of anti-TNF therapy, clinical and laboratory parameters of rheumatic diseases decreased significantly in the patients with AS and RA (P < 0.05). A significant improvement in periodontal attachment measurements were observed in the patients with AS (PPD, 2.18 vs 1.94 mm; P = 0.02; CAL, 2.29 vs.2.02 mm; P = 0.03), but not in RA (PPD, 1.92 vs 2.06 mm; P = 0.06; CAL, 2.14 vs 2.28 mm; P = 0.27). Oral hygiene and gingival inflammation remained unchanged from baseline to 6-M evaluation in AS and RA (P > 0.05). CONCLUSION: Patients with AS under anti-TNF improved periodontal attachment. The mechanism for this effect needs further studies.

Long-term follow-up of anti-infliximab antibodies in radiographic axial spondyloarthritis patients: a marker of drug survival and tapering.

OBJECTIVES: To evaluate the influence of anti-infliximab antibodies (anti-IFX) on 3 different points of care: response/tolerance to infliximab (IFX), tapering strategy, and in a subsequent treatment with a second tumor necrosis factor inhibitor (TNFi). METHODS: A prospective cohort of 60 radiographic axial spondyloarthritis (r-axSpA) patients under IFX were evaluated retrospectively regarding clinical/laboratorial data, IFX levels and anti-IFX, at baseline, after 6, 12-14, 22-24, 48-54, 96-102 weeks and before tapering or switching. RESULTS: Anti-IFX were detected in 27 (45%) patients, of whom 23 (85.1%) became positive in the first year of IFX treatment. In comparison to negative anti-IFX group, anti-IFX positive patients demonstrated the following: less use of methotrexate (MTX) as a concomitant treatment to IFX (5 [18.5%] vs. 14 [42.4%]; p=0.048); more infusion reactions at 22-24 weeks (p=0.020) and 48-54 weeks (p=0.034); more treatment failures (p=0.028) at 48-54 weeks; reduced overall IFX survival (p<0.001); and lower sustained responses (p=0.044). Of note, positive anti-IFX patients exhibited a shorter tapering survival (9.9 months [95% CI 4.0-15.8] vs 63.4 months [95% CI 27.9-98.8]; p=0.004) in comparison with negative anti-IFX patients. Conversely, for patients who failed IFX, positive anti-IFX patients had better clinical response to the second TNFi at 3 (15 [83.3%] vs. 3 [27.3%]; p=0.005) and 6 months (15 [83.3%] vs. 4 [36.4%]; p=0.017) than the negative anti-IFX patients after switching. CONCLUSIONS: This study provided novel data that anti-IFX is a parameter for reduced tapering survival, reinforcing its detection to guide clinical decision. Additionally, we confirmed in a long-term cohort the anti-IFX association with worse IFX performance and as predictor of 2nd TNFi good clinical response.