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Efficacy differences between classical and biological treatment in ankylosing spondylitis
Objectives. The study aims at comparing classical and biological treatment of ankylosing spondylitis (AS) in terms of efficacy and to determine which treatment type is a significant predictor of low disease activity in a reallife clinical situation.
Methods. The study was cross-sectionally designed to include all the patients randomly admitted between January and July 2015 to the “Sfanta Maria” Clinical Hospital Department of Rheumatology and discharged with a diagnosis of AS according to their attending physicians. The retrospectively collected variables (demographics, disease phenotype and activity, treatment, laboratory measures) were analyzed using appropriate statistical tests (Mann Whitney, χ2, linear and logistic regression).
Results. The study sample included 105 cases of established AS with a mean age of 43.2 years: 64 patients (60.9%) were on tumor necrosis factor inhibitors (TNFi: adalimumab, etanercept or infliximab), 55 (52.4%) took non-steroidal anti-inflammatory drugs (NSAIDs) and 30 (28.6%) had sulfasalazine. TNFi were associated with lower disease activity compared to NSAIDs and sulfasalazine and they were significant predictors for low BASDAI (Bath Ankylosing Spondylitis Disease Activity Index), either as mono-therapy or combined with NSAIDs and/or sulfasalazine.
Conclusion. TNFi are more efficacious than NSAIDs and sulfasalazine for the treatment of AS. A combination of TNFi with NSAIDs (and sulfasalazine for peripheral arthritis) would be the ideal therapeutic association.
Keywords: ankylosing spondylitis, TNF inhibitors, NSAIDs, sulfasalazine