Fan Meida, Liu Jian, Zhao Bingcheng, Wu Xinyu, Li Xuefeng, Gu Jieruo
Department of Rheumatology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510630, P.R. China.
Department of Rheumatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China.
Exp Ther Med. 2020 Apr;19(4):3031-3041. doi: 10.3892/etm.2020.8564. Epub 2020 Feb 27.
Ankylosing spondylitis (AS) is a chronic inflammatory disease characterized by lower back pain, enthesitis and asymmetrical peripheral arthritis. Non-steroidal anti-inflammatory drugs (NSAIDs) are recommended as a first-line drug treatment for AS. The aim of the present study was to evaluate the efficacy and safety of NSAIDs in patients with active AS. A total of 9 randomized controlled trials focusing on 6 NSAIDs, including etoricoxib, celecoxib, meloxicam, diclofenac, naproxen and beta-D-mannuronic acid (M2000), were analyzed in the present study. The efficacy endpoints included total pain score, patients' global assessment of disease activity (PGA), Bath Ankylosing Spondylitis Functional Index (BASFI) and the rate of achieving an Assessment in Ankylosing Spondylitis 20% response (ASAS20). The safety endpoints included total adverse events (AEs), gastrointestinal (GI) AEs, withdrawals due to AEs and serious AEs. NSAIDs were compared with the placebo and among themselves using Bayesian network meta-analysis, calculating mean differences (MDs) for continuous data and odds ratios for dichotomous data. The analysis revealed that all NSAIDs were significantly more effective in reducing pain severity than placebo (MDs between -17.49 and -25.99). Similarly, significant improvements in PGA, BASFI and ASAS20 were determined in patients receiving NSAIDs. Furthermore, etoricoxib was ranked as the most efficacious treatment for patients with AS. With regard to safety, there were no significant differences between NSAIDs and placebo in terms of total AEs, withdrawals due to AEs or serious AEs. Furthermore, no significant differences in AEs were identified between M2000 and the placebo. However, patients treated with diclofenac and naproxen had a higher risk of GI events than those taking placebo. In conclusion, the NSAIDs were all highly effective and well-tolerated in the treatment of AS. However, clinicians should take GI toxicity into account when prescribing NSAIDs.
强直性脊柱炎（AS）是一种慢性炎症性疾病，其特征为下背部疼痛、附着点炎和不对称性外周关节炎。非甾体抗炎药（NSAIDs）被推荐作为AS的一线药物治疗。本研究的目的是评估NSAIDs对活动性AS患者的疗效和安全性。本研究分析了总共9项聚焦于6种NSAIDs的随机对照试验，这些NSAIDs包括依托考昔、塞来昔布、美洛昔康、双氯芬酸、萘普生和β-D-甘露糖醛酸（M2000）。疗效终点包括总疼痛评分、患者对疾病活动的整体评估（PGA）、巴斯强直性脊柱炎功能指数（BASFI）以及达到强直性脊柱炎20%反应评估（ASAS20）的比率。安全性终点包括总不良事件（AEs）、胃肠道（GI）不良事件、因不良事件导致的停药以及严重不良事件。使用贝叶斯网络荟萃分析将NSAIDs与安慰剂以及它们彼此之间进行比较，计算连续数据的平均差（MDs）和二分数据的比值比。分析显示，所有NSAIDs在减轻疼痛严重程度方面均显著优于安慰剂（MDs在-17.49至-25.99之间）。同样，接受NSAIDs治疗的患者在PGA、BASFI和ASAS20方面有显著改善。此外，依托考昔被列为对AS患者最有效的治疗药物。在安全性方面，NSAIDs与安慰剂在总不良事件、因不良事件导致的停药或严重不良事件方面没有显著差异。此外，M2000与安慰剂之间在不良事件方面未发现显著差异。然而，接受双氯芬酸和萘普生治疗的患者发生胃肠道事件的风险高于服用安慰剂的患者。总之，NSAIDs在治疗AS方面均非常有效且耐受性良好。然而，临床医生在开具NSAIDs处方时应考虑胃肠道毒性。
