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Nonsteroidal Antiinflammatory Drugs for Axial Spondyloarthritis: A Cochrane Review.
J Rheumatol 2016; 43(3):607-17JR

Abstract

OBJECTIVE

To determine the benefits and harms of nonsteroidal antiinflammatory drugs (NSAID) in axial spondyloarthritis (axSpA).

METHODS

Systematic review using Cochrane Collaboration methodology.

INCLUSION CRITERIA

randomized controlled trials (RCT) and quasi-RCT (to June 2014), investigating NSAID versus any control for axSpA, and observational studies of longterm effects (≥ 6 mos) of NSAID on radiographic progression or adverse events. Main outcomes were pain, Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Functional Index, Bath Ankylosing Spondylitis Metrology Index, radiographic progression, number of withdrawals because of adverse events, and number of serious adverse events. Risk of bias was assessed.

RESULTS

Thirty-five RCT, 2 quasi-RCT, and 2 cohort studies were included. Twenty-nine RCT and 2 quasi-RCT (n = 4356) were included in pooled analyses [traditional NSAID vs placebo (n = 5), cyclooxygenase-2 (COX-2) vs placebo (n = 3), COX-2 vs traditional NSAID (n = 4), NSAID vs NSAID (n = 24), naproxen vs other NSAID (n = 3), and low- vs high-dose NSAID (n = 5)]. Compared with placebo, both traditional and COX-2 NSAID were consistently more efficacious at 6 weeks and equally safe after 12 weeks. No significant differences in benefits or harms between the 2 NSAID classes and no important differences in benefits or withdrawals because of adverse events between different NSAID were found, especially if studies with high risk of bias were excluded. Single studies suggest NSAID may retard radiographic progression, especially by continuous rather than on-demand NSAID use.

CONCLUSION

High-quality evidence indicates that both traditional and COX-2 NSAID are efficacious for treating axSpA, and harms are not different from placebo in the short term. Various NSAID are equally effective.

Authors+Show Affiliations

From the Department of Rheumatology, and Department of Gastroenterology, Leiden University Medical Center, Leiden; Department of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam, Amsterdam; Department of Rheumatology, Atrium Medical Center, Heerlen, the Netherlands; Monash Department of Clinical Epidemiology, Cabrini Hospital, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern, Australia; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, New York, USA.F.P. Kroon, MD, Department of Rheumatology, Leiden University Medical Center; L.R. van der Burg, MD, Department of Gastroenterology, Leiden University Medical Center; S. Ramiro, MD, PhD, Department of Rheumatology, Leiden University Medical Center, and Department of Internal Medicine, Rijnland Medical Center; R.B. Landewé, MD, PhD, Professor, Department of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam, and Department of Rheumatology, Atrium Medical Center; R. Buchbinder, MBBS (Hons), PhD, Professor, Monash Department of Clinical Epidemiology, Cabrini Hospital, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; L. Falzon, MD, PhD, Center for Behavioral Cardiovascular Health, Columbia University Medical Center; D. van der Heijde, MD, PhD, Professor, Department of Rheumatology, Leiden University Medical Center. f.kroon.reum@lumc.nl.From the Department of Rheumatology, and Department of Gastroenterology, Leiden University Medical Center, Leiden; Department of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam, Amsterdam; Department of Rheumatology, Atrium Medical Center, Heerlen, the Netherlands; Monash Department of Clinical Epidemiology, Cabrini Hospital, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern, Australia; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, New York, USA.F.P. Kroon, MD, Department of Rheumatology, Leiden University Medical Center; L.R. van der Burg, MD, Department of Gastroenterology, Leiden University Medical Center; S. Ramiro, MD, PhD, Department of Rheumatology, Leiden University Medical Center, and Department of Internal Medicine, Rijnland Medical Center; R.B. Landewé, MD, PhD, Professor, Department of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam, and Department of Rheumatology, Atrium Medical Center; R. Buchbinder, MBBS (Hons), PhD, Professor, Monash Department of Clinical Epidemiology, Cabrini Hospital, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; L. Falzon, MD, PhD, Center for Behavioral Cardiovascular Health, Columbia University Medical Center; D. van der Heijde, MD, PhD, Professor, Department of Rheumatology, Leiden University Medical Center.From the Department of Rheumatology, and Department of Gastroenterology, Leiden University Medical Center, Leiden; Department of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam, Amsterdam; Department of Rheumatology, Atrium Medical Center, Heerlen, the Netherlands; Monash Department of Clinical Epidemiology, Cabrini Hospital, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern, Australia; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, New York, USA.F.P. Kroon, MD, Department of Rheumatology, Leiden University Medical Center; L.R. van der Burg, MD, Department of Gastroenterology, Leiden University Medical Center; S. Ramiro, MD, PhD, Department of Rheumatology, Leiden University Medical Center, and Department of Internal Medicine, Rijnland Medical Center; R.B. Landewé, MD, PhD, Professor, Department of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam, and Department of Rheumatology, Atrium Medical Center; R. Buchbinder, MBBS (Hons), PhD, Professor, Monash Department of Clinical Epidemiology, Cabrini Hospital, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; L. Falzon, MD, PhD, Center for Behavioral Cardiovascular Health, Columbia University Medical Center; D. van der Heijde, MD, PhD, Professor, Department of Rheumatology, Leiden University Medical Center.From the Department of Rheumatology, and Department of Gastroenterology, Leiden University Medical Center, Leiden; Department of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam, Amsterdam; Department of Rheumatology, Atrium Medical Center, Heerlen, the Netherlands; Monash Department of Clinical Epidemiology, Cabrini Hospital, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern, Australia; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, New York, USA.F.P. Kroon, MD, Department of Rheumatology, Leiden University Medical Center; L.R. van der Burg, MD, Department of Gastroenterology, Leiden University Medical Center; S. Ramiro, MD, PhD, Department of Rheumatology, Leiden University Medical Center, and Department of Internal Medicine, Rijnland Medical Center; R.B. Landewé, MD, PhD, Professor, Department of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam, and Department of Rheumatology, Atrium Medical Center; R. Buchbinder, MBBS (Hons), PhD, Professor, Monash Department of Clinical Epidemiology, Cabrini Hospital, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; L. Falzon, MD, PhD, Center for Behavioral Cardiovascular Health, Columbia University Medical Center; D. van der Heijde, MD, PhD, Professor, Department of Rheumatology, Leiden University Medical Center.From the Department of Rheumatology, and Department of Gastroenterology, Leiden University Medical Center, Leiden; Department of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam, Amsterdam; Department of Rheumatology, Atrium Medical Center, Heerlen, the Netherlands; Monash Department of Clinical Epidemiology, Cabrini Hospital, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern, Australia; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, New York, USA.F.P. Kroon, MD, Department of Rheumatology, Leiden University Medical Center; L.R. van der Burg, MD, Department of Gastroenterology, Leiden University Medical Center; S. Ramiro, MD, PhD, Department of Rheumatology, Leiden University Medical Center, and Department of Internal Medicine, Rijnland Medical Center; R.B. Landewé, MD, PhD, Professor, Department of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam, and Department of Rheumatology, Atrium Medical Center; R. Buchbinder, MBBS (Hons), PhD, Professor, Monash Department of Clinical Epidemiology, Cabrini Hospital, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; L. Falzon, MD, PhD, Center for Behavioral Cardiovascular Health, Columbia University Medical Center; D. van der Heijde, MD, PhD, Professor, Department of Rheumatology, Leiden University Medical Center.From the Department of Rheumatology, and Department of Gastroenterology, Leiden University Medical Center, Leiden; Department of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam, Amsterdam; Department of Rheumatology, Atrium Medical Center, Heerlen, the Netherlands; Monash Department of Clinical Epidemiology, Cabrini Hospital, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern, Australia; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, New York, USA.F.P. Kroon, MD, Department of Rheumatology, Leiden University Medical Center; L.R. van der Burg, MD, Department of Gastroenterology, Leiden University Medical Center; S. Ramiro, MD, PhD, Department of Rheumatology, Leiden University Medical Center, and Department of Internal Medicine, Rijnland Medical Center; R.B. Landewé, MD, PhD, Professor, Department of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam, and Department of Rheumatology, Atrium Medical Center; R. Buchbinder, MBBS (Hons), PhD, Professor, Monash Department of Clinical Epidemiology, Cabrini Hospital, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; L. Falzon, MD, PhD, Center for Behavioral Cardiovascular Health, Columbia University Medical Center; D. van der Heijde, MD, PhD, Professor, Department of Rheumatology, Leiden University Medical Center.From the Department of Rheumatology, and Department of Gastroenterology, Leiden University Medical Center, Leiden; Department of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam, Amsterdam; Department of Rheumatology, Atrium Medical Center, Heerlen, the Netherlands; Monash Department of Clinical Epidemiology, Cabrini Hospital, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern, Australia; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, New York, USA.F.P. Kroon, MD, Department of Rheumatology, Leiden University Medical Center; L.R. van der Burg, MD, Department of Gastroenterology, Leiden University Medical Center; S. Ramiro, MD, PhD, Department of Rheumatology, Leiden University Medical Center, and Department of Internal Medicine, Rijnland Medical Center; R.B. Landewé, MD, PhD, Professor, Department of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam, and Department of Rheumatology, Atrium Medical Center; R. Buchbinder, MBBS (Hons), PhD, Professor, Monash Department of Clinical Epidemiology, Cabrini Hospital, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; L. Falzon, MD, PhD, Center for Behavioral Cardiovascular Health, Columbia University Medical Center; D. van der Heijde, MD, PhD, Professor, Department of Rheumatology, Leiden University Medical Center.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review
Systematic Review

Language

eng

PubMed ID

26834216

Citation

Kroon, Féline P B., et al. "Nonsteroidal Antiinflammatory Drugs for Axial Spondyloarthritis: a Cochrane Review." The Journal of Rheumatology, vol. 43, no. 3, 2016, pp. 607-17.
Kroon FP, van der Burg LR, Ramiro S, et al. Nonsteroidal Antiinflammatory Drugs for Axial Spondyloarthritis: A Cochrane Review. J Rheumatol. 2016;43(3):607-17.
Kroon, F. P., van der Burg, L. R., Ramiro, S., Landewé, R. B., Buchbinder, R., Falzon, L., & van der Heijde, D. (2016). Nonsteroidal Antiinflammatory Drugs for Axial Spondyloarthritis: A Cochrane Review. The Journal of Rheumatology, 43(3), pp. 607-17. doi:10.3899/jrheum.150721.
Kroon FP, et al. Nonsteroidal Antiinflammatory Drugs for Axial Spondyloarthritis: a Cochrane Review. J Rheumatol. 2016;43(3):607-17. PubMed PMID: 26834216.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Nonsteroidal Antiinflammatory Drugs for Axial Spondyloarthritis: A Cochrane Review. AU - Kroon,Féline P B, AU - van der Burg,Lennart R A, AU - Ramiro,Sofia, AU - Landewé,Robert B M, AU - Buchbinder,Rachelle, AU - Falzon,Louise, AU - van der Heijde,Désirée, Y1 - 2016/02/01/ PY - 2015/11/10/accepted PY - 2016/2/3/entrez PY - 2016/2/3/pubmed PY - 2016/12/27/medline KW - ANKYLOSING SPONDYLITIS KW - AXIAL SPONDYLOARTHRITIS KW - METAANALYSIS KW - NONSTEROIDAL ANTIINFLAMMATORY DRUGS KW - SYSTEMATIC REVIEW SP - 607 EP - 17 JF - The Journal of rheumatology JO - J. Rheumatol. VL - 43 IS - 3 N2 - OBJECTIVE: To determine the benefits and harms of nonsteroidal antiinflammatory drugs (NSAID) in axial spondyloarthritis (axSpA). METHODS: Systematic review using Cochrane Collaboration methodology. INCLUSION CRITERIA: randomized controlled trials (RCT) and quasi-RCT (to June 2014), investigating NSAID versus any control for axSpA, and observational studies of longterm effects (≥ 6 mos) of NSAID on radiographic progression or adverse events. Main outcomes were pain, Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Functional Index, Bath Ankylosing Spondylitis Metrology Index, radiographic progression, number of withdrawals because of adverse events, and number of serious adverse events. Risk of bias was assessed. RESULTS: Thirty-five RCT, 2 quasi-RCT, and 2 cohort studies were included. Twenty-nine RCT and 2 quasi-RCT (n = 4356) were included in pooled analyses [traditional NSAID vs placebo (n = 5), cyclooxygenase-2 (COX-2) vs placebo (n = 3), COX-2 vs traditional NSAID (n = 4), NSAID vs NSAID (n = 24), naproxen vs other NSAID (n = 3), and low- vs high-dose NSAID (n = 5)]. Compared with placebo, both traditional and COX-2 NSAID were consistently more efficacious at 6 weeks and equally safe after 12 weeks. No significant differences in benefits or harms between the 2 NSAID classes and no important differences in benefits or withdrawals because of adverse events between different NSAID were found, especially if studies with high risk of bias were excluded. Single studies suggest NSAID may retard radiographic progression, especially by continuous rather than on-demand NSAID use. CONCLUSION: High-quality evidence indicates that both traditional and COX-2 NSAID are efficacious for treating axSpA, and harms are not different from placebo in the short term. Various NSAID are equally effective. SN - 0315-162X UR - https://www.unboundmedicine.com/medline/citation/26834216/Nonsteroidal_Antiinflammatory_Drugs_for_Axial_Spondyloarthritis:_A_Cochrane_Review_ L2 - http://www.jrheum.org/cgi/pmidlookup?view=long&pmid=26834216 DB - PRIME DP - Unbound Medicine ER -