Sulfasalazine treatment for rheumatoid arthritis: a metaanalysis of 15 randomized trials.
OBJECTIVE
To assess the efficacy and safety of sulfasalazine (SSZ) compared to placebo and other disease modifying drugs.


METHODS
A metaanalysis was performed on 15 randomized clinical trials of rheumatoid arthritis (RA) that included SSZ (2 g/day average dose, 36 weeks average followup) as a treatment. Eight trials included a placebo group (PL), 2 hydroxychloroquine (HCQ) (350 mg/day average dose), 3 D-penicillamine (D-Pen) (667 mg/day average dose), and 4 gold sodium thiomalate or aurothioglucose (GST) (25 mg, 1 g/wk).


RESULTS
Compared to PL, SSZ was superior for improvement in erythrocyte sedimentation rate (ESR) (SSZ 37%, PL 14%; p < 0.0001), morning stiffness duration (SSZ 61%, PL 33%; p = 0.008), pain visual analog scale (SSZ 42%, PL 15%; p < 0.0001), articular index (SSZ 46%, PL 20%; p < 0.0001), number of swollen joints (SSZ 51%, PL 26%; p < 0.0001), number of painful joints (SSZ 59%, PL 33%; p = 0.004), and patient global assessment (SSZ 26%, PL 14%; p = 0.02). Withdrawals from study because of adverse drug reactions were increased (SSZ 24%, PL 7%; p < 0.0001), but lack of efficacy dropouts were decreased (SSZ 8%, PL 21%; p < 0.0001). Compared to HCQ, SSZ tended to have fewer lack of efficacy dropouts (SSZ 5%, HCQ 15%; p = 0.055) and improved ESR (SSZ 43%, HCQ 26%; p = 0.10) and morning stiffness duration (SSZ 59%, HCQ 40%; p = 0.09). Compared to GST, adverse drug reaction dropouts were significantly fewer (SSZ 12%, GST 29%; p < 0.0001), while withdrawals due to lack of efficacy were greater (SSZ 13%, GST 4%; p = 0.006). More patients tended to complete treatment taking SSZ (SSZ 69%, GST 61%; p = 0.09).


CONCLUSIONS
Over all, the metaanalysis provides data that support the effectiveness of SSZ as a treatment for RA.
Weinblatt
M E
ME
Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA. meweinblat@bics.bwh.harvard.edu
Reda
D
D
Henderson
W
W
Giobbie-Hurder
A
A
Williams
D
D
Diani
A
A
Docsa
S
S
D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D005260:Female; D006052:Gold Sodium Thiomalate / Q000627:therapeutic use; D006801:Humans; D006886:Hydroxychloroquine / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D010396:Penicillamine / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D012460:Sulfasalazine / Q000627:therapeutic use*
D018501:Antirheumatic Agents; D006052:Gold Sodium Thiomalate; D012460:Sulfasalazine; D006886:Hydroxychloroquine; D010396:Penicillamine