Combination of methotrexate and sulfasalazine is an efficacious option for axial spondyloarthritis in a resource-limited
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ORIGINAL ARTICLE
Combination of methotrexate and sulfasalazine is an efficacious option for axial spondyloarthritis in a resource-limited, real-world clinical setting: a prospective cohort study Arvind Ganapati 1 & Mahasampath Gowri 2 & Belavendra Antonisamy 2 & Debashish Danda 1 Received: 24 July 2020 / Revised: 21 September 2020 / Accepted: 28 September 2020 # International League of Associations for Rheumatology (ILAR) 2020
Abstract Objective Evaluation of response to combination conventional synthetic DMARD (csDMARD) therapy with methotrexate (MTX) and sulfasalazine (SSZ) in active axial spondyloarthritis (axSpA) patients without peripheral arthritis (group 1) as compared to active axSpA with peripheral arthritis (group 2), who are economically constrained for biologicals. Methods A prospective, observational, single-centre, cohort study on 150 consecutive active axSpA patients who were already initiated on the above mentioned combination csDMARD therapy and satisfying the other pre-defined eligibility criteria, was conducted between July 2016 and July 2017 using ASAS20 response as primary outcome measure at 3 and 6 months post treatment. Results ASAS20 response at 3 months was achieved in 31/58 (53.4%) and in 24/36 (66.6%) in groups 1 and 2, respectively (p = 0.2); at 6 months, these figures were 45/76 (59.2%) and 28/44 (63.6%), respectively (p = 0.6). Similarly, there was significant reduction in mean ASAS NSAID index from 29.6 to 14 over 6 months from baseline (p = 0.001), and it was similar in both groups. Using BASDAI ≥ 4 to define active disease, a 34% reduction in requirement of biologicals was also observed. Conclusion In resource-limited population, treatment with combination of methotrexate and sulphasalazine over a period of 6 months is equally efficacious in patients with active axSpA with and without peripheral arthritis, as evidenced by improved ASAS20 response rates, reduction in NSAID use and fewer patients switching to biologicals. Key Points • Combination of MTX+SSZ was efficacious and safe in active axSpA patients who had economic hardships to use biologicals. • This benefit in axSpA patients was similar between those without any peripheral arthritis and those with. • MTX+SSZ combination therapy also demonstrated NSAID sparing action. • Combination of MTX and SSZ also prevented escalation to biological therapy as per a BASDAI score driven policy.
Keywords Ankylosing spondylitis . Axial spondyloarthritis . DMARDs . Methotrexate . Sulfasalazine The data in this manuscript was presented at The Eleventh International Congress on Spondyloarthritides, October 4–6, 2018 at Gent, Belgium as Poster number 60 “Treatment Outcome With Combined Methotrexate, Sulfasalazine And On-Demand NSAIDs In Axial Spondyloarthritis In A Resource-Limited Real World Clinical Practice” and the abstract of the same published in 2018, Vol 36, page 721 of the Journal of Clinical and Experimental Rheumatology Reference to this publication Eleventh International Congress on Spondyloarthritides [Internet]. Clin Exp Rheumato
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