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Research ArticleArticle

Serum C-reactive Protein Levels Demonstrate Predictive Value for Radiographic and Magnetic Resonance Imaging Outcomes in Patients with Active Ankylosing Spondylitis Treated with Golimumab

Jürgen Braun, Xenofon Baraliakos, Kay-Geert A. Hermann, Stephen Xu and Benjamin Hsu
The Journal of Rheumatology September 2016, 43 (9) 1704-1712; DOI: https://doi.org/10.3899/jrheum.160003
Jürgen Braun
From the Rheumazentrum Ruhrgebiet, Herne; Ruhr-University Bochum, Bochum; Department of Radiology, Charité Universitätsmedizin, Berlin, Germany; Biostatistics and Immunology, Janssen Research and Development LLC, Spring House, Pennsylvania, USA.
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  • For correspondence: j.braun@rheumazentrum-ruhrgebiet.de
Xenofon Baraliakos
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Kay-Geert A. Hermann
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Stephen Xu
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Benjamin Hsu
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Abstract

Objective. Serum C-reactive protein (CRP) associates with radiographic progression in patients with ankylosing spondylitis (AS) untreated with tumor necrosis factor (TNF) antagonists. We assessed correlations between serum CRP and radiographic progression/magnetic resonance imaging (MRI)-detected inflammation after 2 years of anti-TNF therapy.

Methods. Patients with active AS receiving golimumab (GOL)/placebo through Week 16 (early escape) or Week 24 (crossover by design), followed by GOL through 4 years, had sera/images obtained through Week 208. Lateral spinal radiographs and spinal MRI were scored with the modified Stoke AS Spine Score (mSASSS) and the AS spine MRI activity (ASspiMRI-a) score, respectively. ANOVA assessed differences based on CRP levels and mSASSS progression. The relationships between CRP levels and mSASSS/ASspiMRI-a were assessed by Spearman correlation and logistic regression.

Results. Of the randomized GO-RAISE patients, 299 (84.0%) had pre- and posttreatment spinal radiographs. Larger proportions of patients with Week 104 CRP ≥ 0.5 mg/dl (n = 47) versus < 0.5 mg/dl (n = 236, 40.4% vs 22.9%, p = 0.0121) had mSASSS changes ≥ 2 at Week 104. Across several visits, serum CRP demonstrated weak associations with mSASSS change (rs ≤ 0.21, p < 0.05, n = 262–293) and moderate associations with ASspiMRI-a change (rs = −0.33 to 0.54, p < 0.05, n = 65–89). Higher baseline CRP was associated with increased risk for syndesmophytes at Week 104/Week 208, and large, short-term decreases in CRP from baseline to Week 14/Week 24 also yielded increased syndesmophyte formation risk.

Conclusion. Elevated CRP after 2 years of anti-TNF treatment correlated with greater radiographic progression risk at 4 years. Elevated CRP at baseline or Week 14/Week 24 of anti-TNF treatment weakly predicted subsequent radiographic progression and modestly predicted residual spinal inflammation in patients with AS treated with anti-TNF. Findings are useful regarding new treatment options in patients treated with anti-TNF. ClinicalTrials.gov: NCT00265083.

Key Indexing Terms:
  • C-REACTIVE PROTEIN
  • RADIOGRAPH
  • MAGNETIC RESONANCE IMAGING
  • ANKYLOSING SPONDYLITIS
  • TUMOR NECROSIS FACTOR
  • GOLIMUMAB

Footnotes

  • Supported by Janssen Research and Development LLC, and Merck/Schering-Plough Research Institute Inc.

  • Accepted for publication May 31, 2016.
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The Journal of Rheumatology: 43 (9)
The Journal of Rheumatology
Vol. 43, Issue 9
1 Sep 2016
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Serum C-reactive Protein Levels Demonstrate Predictive Value for Radiographic and Magnetic Resonance Imaging Outcomes in Patients with Active Ankylosing Spondylitis Treated with Golimumab
Jürgen Braun, Xenofon Baraliakos, Kay-Geert A. Hermann, Stephen Xu, Benjamin Hsu
The Journal of Rheumatology Sep 2016, 43 (9) 1704-1712; DOI: 10.3899/jrheum.160003

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Serum C-reactive Protein Levels Demonstrate Predictive Value for Radiographic and Magnetic Resonance Imaging Outcomes in Patients with Active Ankylosing Spondylitis Treated with Golimumab
Jürgen Braun, Xenofon Baraliakos, Kay-Geert A. Hermann, Stephen Xu, Benjamin Hsu
The Journal of Rheumatology Sep 2016, 43 (9) 1704-1712; DOI: 10.3899/jrheum.160003
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Keywords

C-REACTIVE PROTEIN
RADIOGRAPH
MAGNETIC RESONANCE IMAGING
ANKYLOSING SPONDYLITIS
TUMOR NECROSIS FACTOR
GOLIMUMAB

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Keywords

  • C-REACTIVE PROTEIN
  • RADIOGRAPH
  • MAGNETIC RESONANCE IMAGING
  • ANKYLOSING SPONDYLITIS
  • TUMOR NECROSIS FACTOR
  • GOLIMUMAB

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