ObjectivePeople with axial spondyloarthritis (axSpA) have increased fracture risk relative to the general population, possibly related to chronic inflammation. We assessed the impact of treatment with tumor necrosis factor inhibitors (TNFi) and non‐biologic conventional synthetic disease‐modifying antirheumatic drugs (csDMARDs) on hip and spine fractures in axSpA, relative to nonsteroidal anti‐inflammatory drugs (NSAIDs).MethodsWe conducted a nested case‐control study using 2006‐2021 data from the MerativeTM MarketScan® Database. We included adults 18‐65 years old with ≥1 inpatient or ≥2 outpatient axSpA ICD‐9 or 10 diagnosis codes separated by ≥7 days. The primary outcome was hip and/or spine fracture, defined by ICD‐9 or 10 diagnosis or procedure codes. For each fracture case, we selected up to 10 controls without fracture. We evaluated medication exposure (TNFi, csDMARDs, NSAIDs [referent], or none) hierarchically using pharmacy claims and procedure codes. We assessed the relation of medication exposure with hip and spine fracture risk using unconditional logistic regression with confounder adjustment.ResultsOur main analysis included 13,519 individuals with axSpA, comprising 1,229 cases and 12,290 controls. Individuals on TNFi had 29% lower odds of fracture compared to those on NSAIDs (OR 0.71, 95% CI 0.59‐0.85), accounting for age, sex, and diagnosis year. Results were similar in the fully adjusted model (OR 0.75, 95% CI 0.62‐0.91) and when stratified by sex.ConclusionUsing a large US insurance claims database, we found evidence for a protective effect of TNFi on fracture risk in axSpA underscoring a potential impact of TNFi in diminishing comorbidities linked with axSpA.

中文翻译：

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中轴型脊柱关节炎治疗与髋部和脊柱骨折风险的相关性


目的中轴型脊柱关节炎 （axSpA） 患者骨折风险高于一般人群，可能与慢性炎症有关。相对于非甾体抗炎药 （NSAIDs），我们评估了肿瘤坏死因子抑制剂 （TNFi） 和非生物常规合成疾病缓解抗风湿药 （csDMARDs） 治疗对 axSpA 髋部和脊柱骨折的影响。方法我们使用来自 MerativeTM MarketScan® 数据库的 2006-2021 年数据进行了一项嵌套病例对照研究。我们纳入了 18-65 岁的成年人，他们有 ≥1 个住院或 ≥2 个门诊 axSpA ICD-9 或 10 个诊断代码，间隔 ≥7 天。主要结局是髋部和/或脊柱骨折，由 ICD-9 或 10 诊断或手术代码定义。对于每个骨折病例，我们选择了最多 10 个没有骨折的对照。我们使用药房索赔和程序代码分层评估药物暴露 （TNFi、csDMARDs、NSAIDs [指涉] 或无）。我们使用无条件 logistic 回归和混杂因素调整评估药物暴露与髋部和脊柱骨折风险的关系。结果我们的主要分析包括 13,519 例 axSpA 患者，包括 1,229 例和 12,290 例对照。考虑到年龄、性别和诊断年份，与 NSAID 相比，使用 TNFi 的个体骨折几率降低了 29% （OR 0.71,95% CI 0.59-0.85）。在完全调整的模型 （OR 0.75,95% CI 0.62-0.91） 和按性别分层时，结果相似。结论使用大型美国保险索赔数据库，我们发现了 TNFi 对 axSpA 骨折风险有保护作用的证据，这强调了 TNFi 在减少与 axSpA 相关的合并症方面的潜在影响。