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Conventional DMARD therapy (methotrexate‐sulphasalazine) may decrease the requirement of biologics in routine practice of ankylosing spondylitis patients: A real‐life experience
Author(s) -
Can Meryem,
Aydın Sibel Z.,
Niğdelioğlu Adil,
Atagündüz Pamir,
Direskeneli Haner
Publication year - 2012
Publication title -
international journal of rheumatic diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.795
H-Index - 41
eISSN - 1756-185X
pISSN - 1756-1841
DOI - 10.1111/j.1756-185x.2012.01817.x
Subject(s) - medicine , basdai , ankylosing spondylitis , erythrocyte sedimentation rate , methotrexate , combination therapy , gastroenterology , rheumatoid arthritis , surgery , psoriatic arthritis
Aim The effect of disease‐modifying antirheumatic drugs ( DMARD s) in ankylosing spondylitis ( AS ) is still controversial. We aimed to evaluate the efficacy of sulphasalazine ( SSZ ) mono‐ or combination therapy with methotrexate ( MTX ) in AS patients naive to anti‐tumor necrosis factor alpha ( TNF α) agents. Methods Patients with AS ( n = 87, male : female, 46 : 41) treated with SSZ ( n = 61) or SSZ + MTX ( n = 26) combination and a documented 6‐month follow‐up were evaluated retrospectively. Disease activity was assessed by the B ath A nkylosing S pondylitis D isease A ctivity I ndex ( BASDAI ), C ‐reactive protein and erythrocyte sedimentation rate. Requirement for anti‐ TNF α therapy was assessed after 6 months. Results Mean ( SD ) age was 43.0 (11.0) versus 40.2 (11.1) and disease duration was 11.0 (8.6) versus 8.2 (5.2) years, in the SSZ and SSZ + MTX groups, respectively. Initially, 59% (34/61) of the patients in SSZ monotherapy and 68% (17/26) in the combination arm had BASDAI > 4. At the end of the study, BASDAI scores decreased similarly in both groups (mono: 1.4 [–7–6] versus combination: 0.7 [–3–6] P = 0.2). BASDAI was > 4 in 32.8% (20/61) of patients in the SSZ monotherapy and in 44% (11/26) in the combination arm. Only 4 (6.6%) patients in the SSZ group and 2 (7.7%) in the ombination arm were switched to anti‐ TNF α therapies. Discussion A significant subset of our AS patients responded to SSZ mono or SSZ + MTX combination therapies at 6 months follow‐up. Using BASDAI , the requirement for biological therapies decreased by 21–24%. In AS patients, including those with axial involvement only, DMARD therapy may be a reasonable first alternative to anti‐ TNF α therapy and may delay the switch to biologic agents.