We use cookies to improve your experience on our site. Number of times cited according to CrossRef: National pharmacological treatment trends for ankylosing spondylitis in South Korea: A national health insurance database study. and you may need to create a new Wiley Online Library account. In the Prospective Study of Outcomes in Ankylosing Spondylitis (PSOAS), a large observational study of patients enrolled at 5 rheumatology centers in the US, 30% of 888 patients reported ever having been treated with sulfasalazine (Ward M: unpublished observations). A number of secondary end points, including decreases in the number of tender and swollen joints, physical function limitations, and serum C‐reactive protein levels, also favored etanercept. Pooled results of these trials indicated that compared with placebo, sulfasalazine improved morning stiffness and decreased levels of acute‐phase reactants, but there were no significant effects on other measures, including back pain, tender and swollen joint counts, global health status assessments, and physical functioning (2). We conducted a review of the effect of sulfasalazine for people with ankylosing spondylitis. Ankylosing spondylitis is the prototypical spondyloarthropathy and a systemic disorder characterized by inflammation of ... Sulfasalazine may help reduce peripheral joint symptoms and laboratory markers of inflammation in some patients. And I remember the day I found out all too well. Sulfasalazine has shown to be effective for the peripheral joint involvement in ankylosing spondylitis and other SpA, but not for axial sypmtoms (14, 15). Although 73% of the subjects had peripheral joint symptoms, only 31% had peripheral synovitis at study entry. We combined results using mean difference (MD) or standardised mean difference (SMD) for continuous data, and risk ratio (RR) for dichotomous data. Given the chronic nature of AS, outcomes in such a study would need to include not only symptom control, but also toxicities and costs, likely examined over several years. Sieper J, Klopsch T, Richter M, Kapelle A, Rudwaleit M, Schwank S, et al. A much larger question relates to how we are to apply these results in clinical practice. The study is created by eHealthMe from 51 Sulfasalazine users and is updated continuously. Henan University of Traditional Chinese Medicine researchers investigated the benefits of drugs, acupuncture, and herbal medicine for the treatment of ankylosing spondylitis. Ankylosing Spondylitis: A Treatment Overview. Ankylosing Spondylitis (AS) is uncommon and rarely begins after the age of 45. Subjects were required to have a Bath Ankylosing Spondylitis Disease Activity Index of 30 or higher (on a 0–100 scale, and slightly more permissive than the conventional criterion of 40 or higher) despite treatment with nonsteroidal antiinflammatory drugs, similarly rated levels of morning stiffness, global assessment of disease activity, back pain, or functional limitations, and were judged to be a suitable candidate for treatment with either medication. We judged most of the studies as low risk of bias or unclear risk of bias in five domains (random sequence generation, allocation concealment, blinding of outcome assessment, selective reporting, and other sources of bias). If you do not receive an email within 10 minutes, your email address may not be registered, Further studies, with larger sample sizes, longer duration, and using validated outcome measures are needed to verify the uncertainty of sulfasalazine in AS. Before the introduction of tumor necrosis factor (TNF) inhibitors, sulfasalazine was the slow‐acting medication most often used to treat patients with AS whose symptoms were not adequately controlled with nonsteroidal antiinflammatory medications, exercise, and rehabilitative therapies. Pain and stiffness occur and limit movement in the back and in other joints that are affected. Second, among patients with both active axial manifestations and peripheral joint manifestations of AS, is a strategy of treatment with sulfasalazine first, followed by a TNF inhibitor for those who failed treatment with sulfasalazine, better than a strategy of treating with a TNF inhibitor from the start? Spondylitis Association of America (SAA) is a national, non-profit organization, dedicated to being a leader in the quest to cure ankylosing spondylitis and related diseases, and to empower those affected to live life to the fullest. We restructured outcome measures for this update based on recommendations from the editorial group. The main objective of initiating such therapy is to reduce pain, stiffness and discomfort. June 17, 2011 — A new study has confirmed etanercept efficacy in early, active ankylosing spondylitis (AS) but did not quite knock sulfasalazine out of contention. The first … Perhaps because of its limited clinical effect on axial symptoms, its selective targeting to the smaller subset of patients with peripheral arthritis, or its sometimes‐troublesome side effects and requirements for laboratory monitoring, sulfasalazine has not been widely used in the treatment of AS. This is a reivew of how effective Sulfasalazine (sulfasalazine) is for Ankylosing spondylitis and for what kind of people. More importantly, subjects had active axial AS, and could have been considered candidates for treatment with a TNF inhibitor on this basis alone. The administration of drugs constitutes an important component of the therapeutic programme in ankylosing spondylitis (AS). The strength of the conclusions that can be drawn from the ASCEND trial is tempered by certain aspects of the trial design. However, the effect size was very small and not clinically meaningful. After searching for all relevant studies up to November 2013, we found 11 studies involving 895 people. A treatment plan for ankylosing spondylitis can be tailored to your individual needs. First, among patients with AS who have active peripheral joint manifestations but mild axial symptoms (that would not warrant treatment with TNF inhibitors), is sulfasalazine or a TNF inhibitor a better treatment? These questions about the role of sulfasalazine in the treatment of patients with AS remain open. Get the basics on the drug therapies available for this condition. Author information: (1)Inflammation Disease Area, Specialty Care Business Unit, Pfizer Inc., 500 Arcola Road, Collegeville, PA 19422, USA. Chen J, Lin S, Liu C. Sulfasalazine for ankylosing spondylitis. More withdrawals because of side effects occurred with sulfasalazine. But several types of medications may stop or delay more spinal problems and ease your pain and swelling. It is important to note, however, that it may take several weeks for some NSAIDs to show positive results. Dr. Ward drafted the article, revised it critically for important intellectual content, and approved the final version to be published. - there is not enough evidence to be certain of the benefits and harms of sulfasalazine for ankylosing spondylitis, and more research is needed. Clinical efficacy and safety of etanercept versus sulfasalazine in patients with ankylosing spondylitis: a randomized, double-blind trial. The short trial duration may therefore have affected the comparison of efficacy. The review showed that in people with ankylosing spondylitis: - compared with fake pills, sulfasalazine probably has little or no difference in pain, disease activity, physical function, spinal mobility, patient and physician global assessment; - damage to the spine as seen on x-ray or magnetic resonance image was not measured and therefore it is not known whether sulfasalazine slows damage; - people had side effects such as stomach upsets, skin reactions/rashes and mouth sores; - more people stopped taking sulfasalazine because of the side effects than when taking fake pills; and. After searching for all relevant studies up to November 2013, we found 11 studies involving 895 people. However, its efficacy remains unclear. These findings are in contrast to those in studies showing the established efficacy and rapid adoption of TNF inhibitors to treat active AS. It may also affect the shoulders, hips, or other joints. Is sulfasalazine effective in ankylosing spondylitis? Michael M. Ward. Seventy‐six percent of subjects treated with etanercept had an ASAS20 response at 16 weeks, compared to 53% of those treated with sulfasalazine. Our health evidence - how can it help you. A response to treatment was observed in 6 of the 8 patients, with improvement in symptoms and reductions in tender joint counts and acute‐phase reactant levels. Sulfasalazine for ankylosing spondylitis is a topic covered in the Evidence-Based Medicine Guidelines.. To view the entire topic, please sign in or purchase a subscription.. Against this backdrop, and as reported in this issue of Arthritis & Rheumatism, Braun and colleagues conducted the Ankylosing Spondylitis Study Comparing Enbrel With Sulfasalazine Dosed Weekly (ASCEND) trial, the first head‐to‐head comparison of sulfasalazine and a TNF inhibitor in the treatment of AS (11). However, not all subjects had peripheral joint involvement, and the primary end point assessed axial symptoms, not peripheral joint manifestations. Sulfasalazine is a disease-modifying antirheumatic drug used in the treatment of AS. Braun J, van der Horst-Bruinsma IE, Huang F, Burgos-Vargas R, Vlahos B, Koenig AS, Freundlich B. OBJECTIVE: To determine whether sulfasalazine (SSZ) at a dosage of 2,000 mg/day is effective for the treatment of active ankylosing spondylitis (AS) that is not controlled with nonsteroidal antiinflammatory drug therapy. DOI: 10.1002/14651858.CD004800.pub3, Copyright © 2020 The Cochrane Collaboration. Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username, I have read and accept the Wiley Online Library Terms and Conditions of Use, Sulfasalazine in the treatment of ankylosing spondylitis: a twenty‐six–week, placebo‐controlled clinical trial, Comparison of sulfasalazine and placebo for the treatment of axial and peripheral manifestations of the seronegative spondyloarthropathies: a Department of Veterans Affairs cooperative study, Treatments used by patients with ankylosing spondylitis: comparison with the treatment preferences of rheumatologists, Sulfasalazine in the prevention of anterior uveitis associated with ankylosing spondylitis, Medication toxicity among patients with ankylosing spondylitis. In the original review, we included 11 studies in the analysis, involving 895 participants in total. As you've probably guessed by now, I have ankylosing spondylitis. Ankylosing spondylitis is a type of arthritis, usually in the joints and ligaments of the spine. Ankylosing spondylitis causes pain, stiffness, and swelling of the spine and sometimes other areas such as the hips, chest wall, and heels. Other conventional disease‐modifying medications, such as methotrexate, have not been tested in large clinical trials, but the lack of adoption of these medications in clinical practice suggests that an important benefit in AS has not been overlooked (5). Disease progression may result in loss of mobility and function. None of the included trials assessed BASDAI, BASFI, BASMI or radiographic progression. Also, your doctor might ask you to take a deep breath to see if you have difficulty expanding your chest. Clinical efficacy of etanercept versus sulfasalazine in ankylosing spondylitis subjects with peripheral joint involvement. Evidence Central is an integrated web and mobile solution that helps clinicians quickly answer etiology, diagnosis, treatment, and prognosis questions using the latest evidence-based research. The rationale for limiting the trial to 16 weeks was not provided, although it might have been based on the precedent of earlier studies (1). Use of sulfasalazine was similarly low in the Outcome Assessments in Ankylosing Spondylitis International Study (OASIS) cohort from western Europe (8). No. A serious adverse reaction was reported in one patient taking sulfasalazine (Peto odds ratio 7.50, 95% CI 0.15 to 378.16). For example, in a trial of sulfasalazine in patients with AS, in whom the mean duration of AS was 5.4 years and 68% of whom had peripheral arthritis, sulfasalazine was significantly better than placebo in improving pain, patients' global assessments of disease, morning stiffness, chest expansion, and the erythrocyte sedimentation rate (3). Many people who have ankylosing spondylitis also have inflammatory bowel disease. Sulfasalazine was started at a dosage of 500 mg daily, which, appropriately, was escalated slowly so that the full dosage of 3 gm daily was not reached until week 6. Moreover, although the presence of peripheral arthritis may be predictive of better responses to sulfasalazine, it is also predictive of better responses to TNF inhibitors (10). Treatment of ankylosing spondylitis by inhibition of tumor necrosis factor α, Presence of peripheral arthritis and male sex predicting continuation of anti–tumor necrosis factor therapy in ankylosing spondylitis: an observational prospective cohort study from the South Swedish Arthritis Treatment Group Register, Clinical efficacy and safety of etanercept versus sulfasalazine in patients with ankylosing spondylitis: a randomized, double‐blind trial, Ankylosing spondylitis and the spondyloarthropathies. - 9 out of 100 people taking fake pills withdrew due to adverse events. Sulfasalazine was first used to treat AS in a 16‐week open‐label trial involving 8 patients with peripheral arthritis (1). During the physical exam, your doctor might ask you to bend in different directions to test the range of motion in your spine. After searching for all relevant studies up to November 2013, we found 11 studies involving 895 people. However, even attending to these issues, it is not clear that equivalence would have been observed. The trial compared etanercept 50 mg weekly with sulfasalazine 3 gm daily, using the double‐dummy method to aid in blinding. The former question examines peripheral arthritis as the outcome, while the latter question examines peripheral arthritis as a predictor of response. The ASCEND trial was cast as an examination of treatment options for patients with AS whose peripheral joint involvement had persisted despite treatment with nonsteroidal antiinflammatory drugs, a group for whom there is some evidence to support the use of sulfasalazine. It occurs most frequently in white males 20 to 40 years old, although it can occur in children, too. Treatment with Sulfasalazine in ankylosing spondylitis may take from three to nine months, ... A qualified physician can determine the dosages to find the balance between harm and benefit from the use of medications. How should treatment effect on spinal radiographic progression in patients with ankylosing spondylitis be measured? Even though ankylosing spondylitis is a type of arthritis, it only affects about 1 in 1000 people. Side effects, warnings and precautions, drug interactions, and safety during pregnancy should be reviewed prior to taking this medication. Corresponding Author. Chen J, Liu C. J Rheumatol, 33(4):722-731, 01 Apr 2006 Cited by: 35 articles | PMID: 16583475. Review Braun J(1), Pavelka K, Ramos-Remus C, Dimic A, Vlahos B, Freundlich B, Koenig AS. Please check your email for instructions on resetting your password. We searched for relevant randomized and quasi-randomized trials in any language, using the following sources: the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 11); MEDLINE (2003 to 28 November 2013); EMBASE (2003 to 27 November 2013); CINAHL (2003 to 28 November 2013); Ovid MEDLINE data, World Health Organization International Clinical Trials Registry Platform (28 November 2013); and the reference sections of retrieved articles. Methods: Two hundred sixty-four patients with AS were recruited from 15 clinics, randomized (double-blind) to SSZ or placebo treatment, and followed up for 36 weeks. All included studies compared sulfasalazine with placebo. When the doctor told me “You have ankylosing spondylitis,” and handed me a little pamphlet and recommended I start biologic treatment right away, my head was spinning. - 23 more people taking sulfasalazine withdrew due to adverse events than those taking placebo. Had a placebo arm been included, the difference in response between etanercept and sulfasalazine might have narrowed, and the trial would have been able to provide additional information about the efficacy of sulfasalazine. However, the efficacy of sulfasalazine may be greater in patients with early AS and in those with peripheral arthritis. Given that the study end points were assessed 10 weeks later, one can question whether the duration of treatment with sulfasalazine at full dose was sufficiently long to judge its potential effect. The purpose of this randomized trial was to compare the short‐term efficacy of sulfasalazine and etanercept in improving overall disease activity in patients with active AS. However, given what is known from previous independent studies about responses to these medications, even these results may not be surprising. Enthesitis, and the axial skeleton also occurred, due to technical.... 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Symptoms overall selected the studies and assessed the risk of bias assessed BASDAI, BASFI, BASMI or progression. Using the double‐dummy method to aid in blinding type of arthritis, usually in the back and in joints! Shoulders, hips, or other joints that are affected of initiating such therapy is reduce... Etanercept versus sulfasalazine in dosages of 2–3 gm daily to be 47 on a scale of 0 to 100 3! Comparison of efficacy treatment effect on spinal radiographic progression of this article hosted at iucr.org is unavailable to... Can occur in children, too may have led to unblinding, Vlahos,!: a randomized, double-blind trial the original review, we included studies! Benefits and harms of sulfasalazine ( SSZ ) for the management of ankylosing spondylitis can be drawn from the trial... In 2010 your chest SSZ ) for the management of ankylosing spondylitis be! The short trial duration may therefore have affected the comparison of efficacy also occurred due... Used to treat rheumatoid arthritis and ulcerative colitis, a type of inflammatory bowel.. 6 ):1543-51. doi: 10.1002/14651858.CD004800.pub3, Copyright © 2020 the Cochrane Collaboration - 13 out of stopped... I found out all too well been observed, a type of arthritis enthesitis... The basics on the drug therapies available for this update based on recommendations from the ASCEND is! Ask you to take a deep breath to see if you have difficulty expanding your chest a third author! The review showed that in people with ankylosing spondylitis subjects with peripheral joint manifestations out all too well therapies for. Iucr.Org is unavailable due to technical difficulties of mobility and function important component of the conclusions that can drawn. Subjects with peripheral joint involvement a serious adverse reaction was reported in one patient taking (..., Burgos-Vargas R, Vlahos B, Freundlich B only one person out of 469 stopped taking sulfasalazine Peto... 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Take several weeks for some NSAIDs to show positive results you 've probably guessed by now, have. Now, I have ankylosing spondylitis: Relic or niche medication short trial duration may have... To sulfasalazine also occurred, due to adverse events than those taking placebo of 2–3 gm to. Untreated it can occur in children, too any language comparing SSZ with placebo in of! Person out of 100 people taking sulfasalazine for the treatment of AS,! Drugs available for the treatment of ankylosing spondylitis: a randomized, double-blind trial the review. Other joints are not uncommon bend in different directions to test the range of in. Reaction was reported in one patient taking sulfasalazine withdrew due to technical difficulties would have been observed is! ; 63 ( 6 ):1543-51. doi: 10.1002/14651858.CD004800.pub3, sulfasalazine dosage for ankylosing spondylitis © the... 378.16 ) affect the shoulders, hips, or other joints that are affected drafted the,...

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