BIRMINGHAM, ENGLAND — Tumor necrosis factor antagonists are the most effective treatment available for ankylosing spondylitis, according to the results of a systematic review of randomized placebo-controlled trials comparing the biologics with conventional drugs.
Prior to the introduction of biologic agents, treatment for ankylosing spondylitis (AS) was largely limited to physiotherapy and nonsteroidal antiinflammatory drugs (NSAIDs). Other drugs such as methotrexate and sulfasalazine have not shown the same efficacy for ankylosing spondylitis as they have for rheumatoid arthritis, Sarah Levy, M.D., said at the joint meeting of the British Society for Rheumatology and the German Society for Rheumatology.
From a search on Medline and Embase, Dr. Levy and her associates at University Hospital Lewisham, London, identified 14 trials of pharmacologic management of AS; 9 of the trials were of adequate quality and produced data that were comparable across all studies, she said. Two of the studies evaluated NSAIDs, three evaluated sulfasalazine, and four evaluated TNF-α blocking agents.
Spinal pain visual analog scale scores were available for all treatments, but the Bath Ankylosing Spondylitis Functional Index (BASFI) was available only for NSAIDs and anti-TNF-α treatment, said Dr. Levy, a rheumatologist at the hospital.
Treatment with NSAIDs and sulfasalazine did show significant benefit in BASFI and spinal pain, but the effect sizes were small. (See box.) Most of the effect of treatment with sulfasalazine was seen in patients with both axial and peripheral disease, rather than in those with axial disease alone. In contrast, anti-TNF-α treatment showed highly significant benefits and the largest effect size on both BASFI and spinal pain scores, she said in a poster session.
Four trials evaluating physical exercise regimens also were identified and showed no benefit in spinal pain scores compared with placebo.