PMID- 23253235
OWN - NLM
STAT- MEDLINE
DCOM- 20130529
LR  - 20151119
IS  - 1756-185X (Electronic)
IS  - 1756-1841 (Linking)
VI  - 15
IP  - 6
DP  - 2012 Dec
TI  - Conventional DMARD therapy (methotrexate-sulphasalazine) may decrease the 
      requirement of biologics in routine practice of ankylosing spondylitis patients: 
      a real-life experience.
PG  - 526-30
LID - 10.1111/j.1756-185X.2012.01817.x [doi]
AB  - AIM: The effect of disease-modifying antirheumatic drugs (DMARDs) 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 (TNFalpha) 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 Bath Ankylosing Spondylitis 
      Disease Activity Index (BASDAI), C-reactive protein and erythrocyte sedimentation 
      rate. Requirement for anti-TNFalpha 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-TNFalpha 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-TNFalpha therapy and may delay the switch to biologic agents.
CI  - (c) 2012 The Authors International Journal of Rheumatic Diseases (c) 2012 Asia 
      Pacific League of Associations for Rheumatology and Blackwell Publishing Asia Pty 
      Ltd.
FAU - Can, Meryem
AU  - Can M
AD  - Department of Rheumatology, Pendik Training and Research Hospital, Marmara 
      University, Istanbul, Turkey. meryemkrk@gmail.com
FAU - Aydin, Sibel Z
AU  - Aydin SZ
FAU - Nigdelioglu, Adil
AU  - Nigdelioglu A
FAU - Atagunduz, Pamir
AU  - Atagunduz P
FAU - Direskeneli, Haner
AU  - Direskeneli H
LA  - eng
PT  - Journal Article
DEP - 20120831
PL  - England
TA  - Int J Rheum Dis
JT  - International journal of rheumatic diseases
JID - 101474930
RN  - 0 (Antirheumatic Agents)
RN  - 0 (Biological Products)
RN  - 0 (Biomarkers)
RN  - 0 (Tumor Necrosis Factor-alpha)
RN  - 3XC8GUZ6CB (Sulfasalazine)
RN  - 9007-41-4 (C-Reactive Protein)
RN  - YL5FZ2Y5U1 (Methotrexate)
SB  - IM
MH  - Adult
MH  - Antirheumatic Agents/*therapeutic use
MH  - Biological Products/*therapeutic use
MH  - Biomarkers/blood
MH  - Blood Sedimentation
MH  - C-Reactive Protein/analysis
MH  - Drug Substitution
MH  - Drug Therapy, Combination
MH  - Female
MH  - Humans
MH  - Male
MH  - Methotrexate/*therapeutic use
MH  - Middle Aged
MH  - Retrospective Studies
MH  - Severity of Illness Index
MH  - Spondylitis, Ankylosing/diagnosis/*drug therapy/immunology
MH  - Sulfasalazine/*therapeutic use
MH  - Time Factors
MH  - Treatment Outcome
MH  - Tumor Necrosis Factor-alpha/antagonists & inhibitors
EDAT- 2012/12/21 06:00
MHDA- 2013/05/31 06:00
CRDT- 2012/12/21 06:00
PHST- 2012/12/21 06:00 [entrez]
PHST- 2012/12/21 06:00 [pubmed]
PHST- 2013/05/31 06:00 [medline]
AID - 10.1111/j.1756-185X.2012.01817.x [doi]
PST - ppublish
SO  - Int J Rheum Dis. 2012 Dec;15(6):526-30. doi: 10.1111/j.1756-185X.2012.01817.x. 
      Epub 2012 Aug 31.