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Pharmacological Treatment of Ankylosing Spondylitis

A Systematic Review

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Abstract

The purpose of this study was to review the evidence regarding the efficacy and safety of pharmacological therapies currently available for the treatment of ankylosing spondylitis (AS).

A literature search using MEDLINE from 1966 through to April 2005 and a hand search of abstracts from the American College of Rheumatology (ACR) meetings for 2001 through to 2004 were performed. References of articles retrieved were also searched.

The MEDLINE search yielded 570 citations and 157 abstracts from ACR were identified. Eighty-four studies were randomised controlled trials (RCTs); 53 fulfilled the inclusion criteria (pharmacological treatment of AS and RCT) and were included in this review. Statistical pooling of data was not performed because of the disparate outcome measures used. Eight RCTs found nonselective NSAIDs and two RCTs found cyclo-oxygenase (COX)-2-selective NSAIDs to be superior to placebo for relief of pain and improvement in physical function. Twenty-nine RCTs showed comparable efficacy and safety between nonselective NSAIDs. One RCT showed no difference between methylprednisolone 1g and 375mg. Seven RCTs assessing the efficacy of sulfasalazine (sulphasalazine) and two RCTs of methotrexate provided contradictory evidence as to their benefit for treatment of AS. One RCT showed intravenous pamidronate 60mg to be more effective than 10mg intravenously for the treatment of axial pain. All six RCTs of anti-tumour necrosis factor (TNF)-α agents demonstrated superiority to placebo for the treatment of axial and peripheral symptoms.

Nonselective as well as COX-2-selective NSAIDs can be used for pain control in patients with AS. Other proven treatment options include sulfasalazine for the treatment of peripheral joint symptoms, while limited evidence supports the use of pamidronate or methotrexate, which require further studies. Anti-TNFα agents have been found very effective for the treatment of both peripheral and axial symptoms in patients with AS, but their use is limited by cost and uncertainty over long-term efficacy and safety.

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Acknowledgements

This literature review was supported by Merck and Co., Inc. Dr Pauline Boulos and Dr Stuart McLeod received funding from Merck and Co., Inc. for this review. Dr Maxime Dougados did not receive any grant and/or honorarium for his participation regarding this manuscript. Dr Dougados is a member of Merck Arthritis Advisory Board. Elke Hunsche is an employee of Merck and Co., Inc.

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Authors and Affiliations

  1. Department of Medicine, McMaster University, Hamilton, Ontario, Canada

    Pauline Boulos

  2. Hôpital Cochin, René Descartes Université, Paris, France

    Maxime Dougados

  3. Child and Family Research Institute, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada

    Stuart M. MacLeod

  4. Outcomes Research, Merck and Co., Inc., Whitehouse Station, New Jersey, USA

    Elke Hunsche

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  1. Pauline Boulos
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  2. Maxime Dougados
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  3. Stuart M. MacLeod
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  4. Elke Hunsche
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Correspondence to Pauline Boulos.

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Boulos, P., Dougados, M., MacLeod, S.M. et al. Pharmacological Treatment of Ankylosing Spondylitis. Drugs 65, 2111–2127 (2005). https://doi.org/10.2165/00003495-200565150-00004

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