NSAIDs consumption is linked to patient-assessed disease activity and decreases with use of TNF inhibitors

Patients with inflammatory arthritis requiring TNF inhibitor (TNFi) therapy use more non-steroidal anti-inflammatory drugs (NSAIDs) than general population controls. However, NSAID consumption is significantly reduced following the initiation of a first-line biologic drug. Patients with the highest NSAID use have worse patient-reported outcome measures but physician outcome measures are similar, which may suggest a non-inflammatory mechanism of the pain.

TNFi therapy is effective in controlling several rheumatic diseases and more specifically has been shown to reduce pain. NSAIDs are commonly used for the management and treatment of pain and stiffness in inflammatory arthritides and are the first-line treatment for axial spondyloarthritis. Dr Olafur Palsson (University Hospital Reykjavik, Iceland) et al. aimed to gain a better understanding of the consumption of NSAIDs in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and ankylosing spondylitis (AS) as compared with the general population, as well as to explore their relationship with disease activity measures. Additionally, the impact of TNFi therapy on NSAID prescription rates was evaluated.

To accomplish these goals, the research group initiated ICEBIO, an Icelandic nationwide database on patients treated with biological disease-modfiying anti-rheumatic drugs (DMARDs) due to inflammatory joint diseases; including RA, PsA, and AS. Data for all patients with inflammatory arthritis was extracted along with all filed prescriptions for NSAIDs made 2 years before and 2 years after the initiation of TNFi therapy. This is available through the Icelandic Directorate of Health, which operates a prescription database that includes over 90% of all drug prescriptions in Iceland. For each patient, NSAID prescriptions of 5 randomly selected individuals matched on age, sex, and calendar time of TNF inhibition were extracted as a control. As such, data of 952 patients was included (366 RA, 251 PsA, 218 AS) along with 4,760 controls. The drug database yielded a total of 5,600 and 8,600 prescriptions for patients and controls, respectively.

The control group was prescribed a mean of 23 defined daily doses (DDD) of NSAIDs per year. In total, the ICEBIO patients were prescribed 6.7 times more DDDs of NSAIDs than the controls at a mean of 149 per year. After initiation of TNFi therapy, the use of NSAIDs was reduced to a mean of 85 DDD per year, or 3.9 times that of the controls. Consumption was reduced by 43% (mean 148 to 85 DDD/year) in RA patients, 43% in the PsA group (157 to 90 DDD/year), and 47% in the AS group (154 to 83 DDD/year).

In terms of measuring disease activity, the group was divided into the 20% of patients who consumed the highest amount of NSAIDs and the remaining 80%. These groups were very similar in patient demographics, although the high-consuming patient group trended towards longer disease. When TNFi therapy was initiated, the 2 groups appeared to be similarly related with regard to number of swollen (4.5 to 4.2) or tender (5.4 to 5.5) joints in RA, or to physician global VAS assessment (56 vs 57). On the other hand, patient-reported outcome measures revealed small but significant differences between groups. The high-consuming patient group reported worse VAS pain scores (65 vs 60), VAS global health scores (70 vs 65), and HAQ-DI scores (1.19 vs 1.03).

1.  Palsson O, et al. Abstract OP0001. EULAR 2019.

Posted on 4 September 201917 May 2024