Should non-steroidal anti-inflammatory drugs be used continuously in ankylosing spondylitis? - 12/07/14

Doi : 10.1016/j.jbspin.2014.01.003

Dewi Guellec ^a, Gaëtane Nocturne ^b, Zuzana Tatar ^c, Thao Pham ^d, Jérémie Sellam ^e, Alain Cantagrel ^f, Alain Saraux ^a,^⁎
^a Rheumatology department, CHU Cavale-Blanche, Brest University Hospital, boulevard Tanguy-Prigent, 29200 Brest, France
^b Rheumatology department, CHU Le-Kremlin-Bicêtre, Le-Kremlin-Bicêtre, France
^c Oncology department, centre Jean-Perrin, Clermont-Ferrand, France
^d Rheumatology department, CHU Sainte-Marguerite, Marseille, France
^e Rheumatology department, Hôpital Saint-Antoine, AP–HP, Pierre-et-Marie-Curie Paris 6 University, Paris, France
^f Rheumatology department, Hôpital Purpan, Toulouse, France

^⁎Corresponding author. Tel.: +33 298 347 267; fax: +33 298 493 627.

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Abstract

Objective

The 2010 update of ASAS/EULAR recommendations for managing ankylosing spondylitis (AS) specify that continuous non-steroidal anti-inflammatory drug (NSAID) treatment should be preferred in patients with persistently active, symptomatic disease. Here, our objective was to assess whether continuous NSAID therapy improves disease control and influences radiographic progression compared to on-demand therapy. We also assessed the safety profiles of both regimens.

Methods

We performed a review by searching the PubMed and Embase databases using two MeSH term combinations to compare continuous and on-demand NSAID therapy in terms of disease control, radiographic progression, and safety.

Results

The only study evaluating the impact of continuous NSAID therapy on disease control showed no significant difference with on-demand therapy. In four studies, continuous treatment was associated with slower radiographic progression, as assessed in three studies using the modified Stoke Ankylosing Spondylitis Spinal Score (m-SASSS). Three studies compared the safety of continuous and on-demand celecoxib, two in osteoarthritis and one in AS, and found no significant differences regarding the usual side effects of Cox-2 inhibitors.

Conclusions

Several studies showed slower radiographic progression with continuous NSAID therapy in AS. No studies demonstrated superiority of continuous NSAID therapy regarding symptom control. Continuous NSAID therapy (at least with Cox-2 inhibitors) does not modify safety compared to on-demand therapy.

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Keywords : Ankylosing spondylitis, Disease progression, Drug administration schedule, Systematic review