Methylsulphasalazine in Rheumatoid Arthritis

Astbury, Carol; Hill, Jackie; Lowe, J. R.; Campbell, David I.; Bird, H. A.

doi:10.1093/rheumatology/29.6.465

Cited by 2 publications

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“…Some in vitro and in vivo animal studies havc suggested that SSZ has inherent immunologic activities that SP and ASA do not possess (22)(23)(24). The significance of thcse observations is difficult to assess, but a study of methylsulfasalazinc (MSSZ) in RA has provided indircct evidence supporting thc theory that SSZ may havc antirheumatic properties of its own (25). MSSZ is more lipid soluble than SSZ, thus enabling the parent molecule to be absorbed largely unchangcd in the small intestine.…”

Section: Discussionmentioning

confidence: 99%

Which is the active moiety of sulfasalazine in ankylosing spondylitis? A randomized, controlled study

Taggart

Gardiner

McEvoy

et al. 1996

Arthritis & Rheumatism

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Objective. To compare the efficacy of sulfasalazine (SSZ) with its two moieties, 5-aminosalicylic acid (ASA) and sulfapyridine (SP), in patients with active ankylosing spondylitis (AS).Methods. A 26-week randomized, observerblinded, 2-center, controlled study of treatment with either SSZ, ASA, or SP was conducted in 90 patients with active AS. Patients were evaluated at baseline and at monthly intervals, using several clinical and laboratory measures of disease activity. A global assessment of treatment efficacy was made by both patients and observers at the end of the study period.Results. There were no significant changes in any of the parameters of disease activity in the ASA treatment group. Levels of serum IgC, IgA, and IgM fell significantly during treatment with SP, but none of the other changes reached statistical significance. Plasma viscosity and IgG and IgA levels fell significantly during treatment with SSZ, as did nocturnal spinal pain and overall spinal pain. Patients and observers reported a favorable outcome after treatment with SSZ or SP significantly more often than with ASA treatment.Conclusion. SP appears to be the active moiety in AS, although there was a trend suggesting a better outcome in the SSZ group compared with the SP group, perhaps suggesting the importance of a common sulfonamide structure for efficacy. __ ~

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Section: Discussionmentioning

confidence: 99%

Which is the active moiety of sulfasalazine in ankylosing spondylitis? A randomized, controlled study

Taggart

Gardiner

McEvoy

et al. 1996

Arthritis & Rheumatism

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Sulfasalazine

Rains¹,

Noble²,

Faulds³

1995

Drugs

104

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Sulfasalazine was first used for rheumatic polyarthritis in the 1940s and in the past 2 decades has become firmly established as a disease-modifying antirheumatic drug (DMARD). The drug is split by the action of bacterial azoreductases in the large intestine into sulfapyridine and mesalazine (mesalamine, 5-aminosalicylic acid), although whether the parent molecule or the sulfapyridine moiety, or both, is the active principle remains uncertain. Sulfasalazine is an effective treatment for rheumatoid arthritis (RA), producing improvements in disease parameters similar to those seen with penicillamine, hydroxychloroquine or oral or parenteral gold in comparative clinical trials. However, there are no direct comparisons of the drug with methotrexate. Most adverse events associated with sulfasalazine are minor and tend to occur within 3 months of starting therapy. A meta-analysis of studies investigating DMARD therapy, which included almost 5000 evaluable patients, concluded that sulfasalazine was close to methotrexate in terms of efficacy but was slightly less well tolerated. However, unlike sulfasalazine, many DMARDs may be unsuitable for women who are, or may become, pregnant because of their potential to cause teratogenic effects. Sulfasalazine may also offer a more rapid onset of action than other DMARDs and may slow down the radiological progression of RA. Combination therapy with other DMARDs, particularly methotrexate, appears more effective than single DMARD therapy. If the safety of these regimens is shown in large numbers of patients they are likely to become more widely used in the future. Sulfasalazine is a therapy of first choice in patients with RA and may be the DMARD of choice in women who are, or may become, pregnant.

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Methylsulphasalazine in Rheumatoid Arthritis

Cited by 2 publications

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Which is the active moiety of sulfasalazine in ankylosing spondylitis? A randomized, controlled study

Which is the active moiety of sulfasalazine in ankylosing spondylitis? A randomized, controlled study

Sulfasalazine

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