Cochrane Review:NSAIDs Equally Effective for Axial Spondyloarthritis Save

Until the advent of TNF inhibitor therapy, nonsteroidal antiinflammatory drugs (NSAIDs) were the only effective treatment for ankylosing spondylitis or spondyloarthritis (SpA).  More recently, several reports have suggested clinical and radiographic benefits to sustained NSAID use.

Led by researchers from Leiden, a Cochrane review examined the effects of NSAID therapy (compared to any control) in the treatment of axial SpA (axSpA).  Primary outcomes were 6 months and beyond using accepted clinical indices (e.g., Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Functional Index, Bath Ankylosing Spondylitis Metrology Index), while also examining radiographic or adverse effects.

Twenty-nine randomized controlled trials (RCT) and 2 quasi-RCT (n = 4356) were included - 5 examined traditional NSAID vs placebo; 3 examined cyclooxygenase-2 (COX-2) vs placebo;  4 examined COX-2 vs traditional NSAID, 24 RCTs looked at NSAID vs NSAID, 3 RCTs examined naproxen vs other NSAID  and 5 examined low- vs high-dose NSAID.

Both traditional and COX-2 NSAID were consistently more efficacious at 6 weeks and equally safe after 12 weeks when compared to placebo. There were no significant differences in clinical benefits or harms between the 2 NSAID classes and no important differences in benefits or withdrawals because of adverse events between different NSAIDs were found. Single studies suggest NSAID may retard radiographic progression, especially by continuous rather than on-demand NSAID use.

Both traditional and COX-2 NSAID are efficacious for treating axSpA, and harms are not different from placebo in the short term.