Impact of tumour necrosis factor-α inhibitors on non-invasive indices of hepatic steatosis and fibrosis in patients with ankylosing spondylitis.

Abstract

Objective: Tumour necrosis factor-α (TNF-α) has been associated with non-alcoholic fatty liver disease (NAFLD) and its severity. This study aimed to evaluate for first time changes in non-invasive indices of hepatic steatosis and fibrosis in patients with ankylosing spondylitis (AS) after treatment with TNF-α inhibitors.

Methods: In this retrospective study, non-invasive indices of steatosis and fibrosis were evaluated in patients with AS treated with TNF-α inhibitors before the initiation of treatment (baseline) and after at least 6 months of treatment (endpoint). Steatosis was evaluated with hepatic steatosis index (HSI) and fibrosis with three indices [fibrosis-4 (FIB-4) index, aspartate aminotransferase to platelet ratio index (APRI), and body mass index (BMI)-aspartate aminotransferase-to-alanine aminotransferase ratio-diabetes mellitus (BARD)]. The efficacy of TNF-α inhibitors was evaluated by serum C-reactive protein (CRP) and Ankylosing Spondylitis Disease Activity Score with CRP.

Results: Fifty-two patients were included in this study and were treated with TNF-α inhibitors for 8.1 months (interquartile range 6.5-11.3 months). There was no change in HSI between baseline and endpoint, whereas FIB-4 (from 0.64 ± 0.23 to 0.83 ± 0.48; p < 0.001) and APRI (from 0.16 ± 0.06 to 0.23 ± 0.13; p < 0.001) increased; BARD was not affected. These results were independent of different TNF-α inhibitors, sex, BMI, and age.

Conclusions: TNF-α inhibitors may have a neutral impact on hepatic steatosis, but a negative impact on hepatic fibrosis indices, findings requiring validation in prospective clinical studies with liver imaging or paired liver biopsies.