Anti-TNF alpha may reduce structural damage in AS

Etanercept may reduce cartilage turnover and increase repair rates in patients with ankylosing spondylitis (AS), according to a recent report. The authors suggest that such structural changes may account for the therapeutic efficacy of anti-TNF alpha therapies in AS.Principle author Dr Walter Maksymowych comments that anti-TNF alpha therapies are effective for reducing structural damage in rheumatoid arthritis (RA) but that it is not known if these they can prevent similar damage in AS.To investigate, the researchers evaluated 18 patients who were recruited to a placebo controlled trial of etanercept in AS for 16 weeks and 14 patients who were receiving infliximab for disease refractory to conventional therapy. The study focused on two novel biomarkers of cartilage turnover: C2C and 846 epitope.Etanercept treatment was associated with a significant reduction in C2C levels and increases in the 846 epitope (P=0.005 and p=0.01, respectively). Changes in C2C levels correlated with changes in ESR and CRP (p=0.04, p=0.048).Maksymowych's group reports that significant changes in C2C were not evident in infliximab patients, but significant reductions were observed in MMP-3 and MMP-1 levels, which were not seen in the etanercept group."Our data suggest that an anti-TNF-alpha agent, etanercept, may modify cartilage turnover. These include decreased degradation of type II collagen and increased turnover of aggrecan," the authors conclude. Maksymowych and colleagues add that the additional therapeutic properties of some anti-TNF-alpha agents in AS, such as infliximab, may be related to decreased expression of MMP and call for further investigation.Reference...