Article: sulfasalazine dosage for ankylosing spondylitis
December 22, 2020 | Uncategorized
Major outcomes included: pain, Bath ankylosing spondylitis disease activity index (BASDAI), Bath ankylosing spondylitis function index (BASFI), Bath ankylosing spondylitis metrology index (BASMI), radiographic progression, total number of withdrawals due to adverse events, and serious adverse events. 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. 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. It is important to note, however, that it may take several weeks for some NSAIDs to show positive results. Sulfasalazine has shown to be effective for the peripheral joint involvement in ankylosing spondylitis and other SpA, but not for axial sypmtoms (14, 15). He or she might try to reproduce your pain by pressing on specific portions of your pelvis or by moving your legs into a particular position. A statistically significant benefit in reducing the erythrocyte sedimentation rate and easing spinal stiffness was mentioned in the previous version. Working off-campus? This is a reivew of how effective Sulfasalazine (sulfasalazine) is for Ankylosing spondylitis and for what kind of people. To date, no intervention is available that alters the underlying mechanism of inflammation in AS. 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. Clinical efficacy and safety of etanercept versus sulfasalazine in patients with ankylosing spondylitis: a randomized, double-blind trial. We did not add any new studies to this review following the updated search. 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. Author information: (1)Inflammation Disease Area, Specialty Care Business Unit, Pfizer Inc., 500 Arcola Road, Collegeville, PA 19422, USA. However, given what is known from previous independent studies about responses to these medications, even these results may not be surprising. [J Chen, C Liu] PMID 15846731 . Disagreements on the inclusion of the studies were resolved, when necessary, by recourse to a third review author. Ankylosing Spondylitis: A Treatment Overview. Pain and stiffness occur and limit movement in the back and in other joints that are affected. In the original review, we included 11 studies in the analysis, involving 895 participants in total. - there is not enough evidence to be certain of the benefits and harms of sulfasalazine for ankylosing spondylitis, and more research is needed. We combined results using mean difference (MD) or standardised mean difference (SMD) for continuous data, and risk ratio (RR) for dichotomous data. 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. Learn about our remote access options, National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland. The dose‐escalation schedule of sulfasalazine should also be considered when evaluating comparisons of study end points early in the trial. No. Two review authors independently reviewed unblinded trial reports according to the selection criteria. 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). Some evidence suggests that sulfasalazine may reduce recurrences of uveitis among patients with AS, but there is no evidence that it prevents or slows the progression of spinal fusion or structural damage (6). 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. Eighty‐five patients with active ankylosing spondylitis (AS) were randomized to receive either sulfasalazine (≤3 gm/day, mean 2.5) or placebo for 26 weeks. 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. However, not all subjects had peripheral joint involvement, and the primary end point assessed axial symptoms, not peripheral joint manifestations. E-mail address: wardm1@mail.nih.gov. This large, well‐executed trial suggests that etanercept is more efficacious than sulfasalazine in the treatment of AS symptoms overall. We do not know whether unblinding to sulfasalazine also occurred, due to its common gastrointestinal and neurologic side effects. 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. - People who took placebo rated their pain to be 50 on a scale of 0 to 100 after 3 to 36 months. Eighty-five patients with active ankylosing spondylitis (AS) were randomized to receive either sulfasalazine (≤3 gm/day, mean 2.5) or placebo for 26 weeks. 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). Arthritis Rheum. Different parameters were used to assess pain. A serious adverse reaction was reported in one patient taking sulfasalazine (Peto odds ratio 7.50, 95% CI 0.15 to 378.16). Further studies, with larger sample sizes, longer duration, and using validated outcome measures are needed to verify the uncertainty of sulfasalazine in AS. Other clinical manifestations include peripheral arthritis, enthesitis, and extra-articular organ involvement. Chen J, Liu C. J Rheumatol, 33(4):722-731, 01 Apr 2006 Cited by: 35 articles | PMID: 16583475. Review The pooled MD for back pain measured on a 0 to 100 mm visual analogue scale was -2.96 (95% confidence interval (CI) -6.33 to 0.41; absolute risk difference 3%, 95% CI 1% to 6%; 6 trials). Eighteen percent of subjects had previously been treated with sulfasalazine. Noting that some professional organizations recommend that a trial of sulfasalazine be considered for patients with active peripheral arthritis before a TNF inhibitor is prescribed, patients with peripheral arthritis were targeted for enrollment, but this was not an inclusion criterion. 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. We conducted a review of the effect of sulfasalazine for people with ankylosing spondylitis. The administration of drugs constitutes an important component of the therapeutic programme in ankylosing spondylitis (AS). 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. 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). Clinical efficacy of etanercept versus sulfasalazine in ankylosing spondylitis subjects with peripheral joint involvement. 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. Acupuncture and herbs outperform sulfasalazine for the alleviation of ankylosing spondylitis. Ankylosing spondylitis is a type of arthritis, usually in the joints and ligaments of the spine. This is also reflected in the cur-rent ASAS/European League Against Rheumatism recommendations for the management of ankylosing spondylitis Other studies, however, indicated that the benefit of sulfasalazine was limited to improvements in the peripheral arthritis itself, whereas improvements in the axial symptoms were not observed in patients with peripheral arthritis (4). 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. Number of times cited according to CrossRef: National pharmacological treatment trends for ankylosing spondylitis in South Korea: A national health insurance database study. Sulfasalazine is an anti-inflammatory drug and is also used to treat rheumatoid arthritis and ulcerative colitis, a type of inflammatory bowel disease. Sulfasalazine for ankylosing spondylitis. Sulfasalazine for ankylosing spondylitis. Although the results of the ASCEND trial suggest a greater short‐term clinical benefit with etanercept, even in this group of patients who may be more sulfasalazine‐responsive, this trial does not address more clinically relevant questions that might elucidate whether sulfasalazine fills a niche in the strategies of AS treatment. 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. These questions about the role of sulfasalazine in the treatment of patients with AS remain open. Use of sulfasalazine was similarly low in the Outcome Assessments in Ankylosing Spondylitis International Study (OASIS) cohort from western Europe (8). Sulfasalazine is a disease-modifying antirheumatic drug used in the treatment of AS. Ankylosing Spondylitis is a very painful and debilitating arthritis of the spine. These questions separate the evaluation of sulfasalazine's effects on peripheral arthritis from its effects on overall AS in patients who also have peripheral manifestations, a distinction not always clearly made in the literature. 2011 Jun;63(6):1543-51. doi: 10.1002/art.30223. Although prior ineffectiveness of sulfasalazine was an exclusion criterion, the comparisons would have been cleaner if subjects had been required to be treatment naive, having never received either active treatment at study start. Two reviewers independently selected the studies and assessed the methodological quality. Average maintenance dose is 2g (4 tablets) daily, although higher doses are not uncommon. 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. During the physical exam, your doctor might ask you to bend in different directions to test the range of motion in your spine. The strength of the conclusions that can be drawn from the ASCEND trial is tempered by certain aspects of the trial design. However, even attending to these issues, it is not clear that equivalence would have been observed. This outcome was not measured in the studies. 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. These findings are in contrast to those in studies showing the established efficacy and rapid adoption of TNF inhibitors to treat active AS. We conducted a review of the effect of sulfasalazine for people with ankylosing spondylitis. Sulfasalazine helps by decreasing bowel inflammation and abdominal (belly) pain. Although NSAIDs are commonly the first line of medications used to treat ankylosing spondylitis and related diseases, sometimes they aren’t enough to control the symptoms. JC: Registered the title; developed the protocol; searched for relevant studies; selected the studies and assessed their risk of bias; extracted and synthesized the data; and wrot Braun J(1), Pavelka K, Ramos-Remus C, Dimic A, Vlahos B, Freundlich B, Koenig AS. We evaluated randomized and quasi-randomized trials examining the benefits and harms of sulfasalazine on AS. After searching for all relevant studies up to November 2013, we found 11 studies involving 895 people. 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? Bath ankylosing spondylitis function index (BASFI), Bath ankylosing spondylitis metrology index (BASMI), Total number of withdrawals due to adverse events. - 23 more people taking sulfasalazine withdrew due to adverse events than those taking placebo. 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. Use the link below to share a full-text version of this article with your friends and colleagues. DOI: 10.1002/14651858.CD004800.pub3, Copyright © 2020 The Cochrane Collaboration. Post Views: 219. And I remember the day I found out all too well. Corresponding Author. Ankylosing spondylitis causes pain, stiffness, and swelling of the spine and sometimes other areas such as the hips, chest wall, and heels. Eleven percent of etanercept‐treated subjects had injection‐site reactions that may have led to unblinding. Chen J, Lin S, Liu C. Sulfasalazine for ankylosing spondylitis. Interestingly, the initial studies of TNF inhibitors in AS also enrolled a high proportion of patients with peripheral arthritis, and those with peripheral arthritis may respond better to treatment with TNF inhibitors than might patients with purely axial AS (9, 10). The former question examines peripheral arthritis as the outcome, while the latter question examines peripheral arthritis as a predictor of response. 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. Ankylosing spondylitis (AS) is a chronic, multisystem inflammatory disorder primarily involving the sacroiliac (SI) joints and the axial skeleton. To evaluate the benefits and harms of sulfasalazine for the treatment of ankylosing spondylitis (AS). Interventions for treating psoriatic arthritis, Anti-TNF-alpha drugs for treating ankylosing spondylitis, Self management programme for ankylosing spondylitis, Tumor necrosis factor (TNF) inhibitors for the treatment of psoriatic arthritis. Our findings are summarised below. National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland. The notable aspect of this study is that the trial enrolled patients with AS who were the most likely candidates to respond to sulfasalazine, thereby providing a more rigorous challenge to etanercept. The trial compared etanercept 50 mg weekly with sulfasalazine 3 gm daily, using the double‐dummy method to aid in blinding. None of the included trials assessed BASDAI, BASFI, BASMI or radiographic progression. Even though ankylosing spondylitis is a type of arthritis, it only affects about 1 in 1000 people. 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). Management of ankylosing spondylitis (AS) is challenged by the progressive nature of the disease. Surveys in the US in the 1990s indicated that sulfasalazine was being administered to fewer than 20% of patients, even among those with moderately active or very active AS (5, 7). Learn more. Disease progression may result in loss of mobility and function. A treatment plan for ankylosing spondylitis can be tailored to your individual needs. More withdrawals because of side effects occurred with sulfasalazine. Henan University of Traditional Chinese Medicine researchers investigated the benefits of drugs, acupuncture, and herbal medicine for the treatment of ankylosing spondylitis. The full text of this article hosted at iucr.org is unavailable due to technical difficulties. It occurs most frequently in white males 20 to 40 years old, although it can occur in children, too. Sulfasalazine is a slow-acting anti-rheumatic drug (SAARD) that may be used to treat certain people with ankylosing spondylitis (AS). 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. Data were extracted from the chosen studies and … Most subjects had relatively early and active AS. 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? Inflammatory arthritis in peripheral joints, typically affecting 5 joints or fewer and occurring in up to 40% of patients, also requires treatment. 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. Dr. Ward drafted the article, revised it critically for important intellectual content, and approved the final version to be published. After searching for all relevant studies up to November 2013, we found 11 studies involving 895 people. Sieper J, Klopsch T, Richter M, Kapelle A, Rudwaleit M, Schwank S, et al. We conducted a review of the effect of sulfasalazine for people with ankylosing spondylitis. The review showed that in people with ankylosing spondylitis: 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. Many would consider 4–6 months of treatment with sulfasalazine at 3 gm daily to be an adequate trial (12). Untreated it can lead to permanent fusing of the spinal column. 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. 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. Ankylosing Spondylitis (AS) is uncommon and rarely begins after the age of 45. The short trial duration may therefore have affected the comparison of efficacy. Methotrexate (MTX), a widely used disease-modifying antirheumatic drug (DMARD), is effective for rheumatoid arthritis (RA), and so might work for AS. Braun J, van der Horst-Bruinsma IE, Huang F, Burgos-Vargas R, Vlahos B, Koenig AS, Freundlich B. Our health evidence - how can it help you. Ankylosing spondylitis (AS) is a chronic inflammatory disease of unknown cause and affects mainly the spine, but can also affect other joints. and you may need to create a new Wiley Online Library account. There was a statistically significant improvement, compared with baseline, in most of the clinical variables in patients receiving the active drug. Currently available conventional treatments are palliative at best, and often fail to control symptoms in the long term. Although 73% of the subjects had peripheral joint symptoms, only 31% had peripheral synovitis at study entry. The same authors independently assessed the risk of bias of included trials and entered the data extracted from the included trials. 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). Michael Weisman, and the axial skeleton remember the day I found out all well. Also affect the shoulders, hips, or other joints that are affected independently unblinded. Chinese Medicine researchers investigated the benefits and harms of sulfasalazine for people with ankylosing spondylitis AS! 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