The effects of an orally administered probiotic on sulfasalazine metabolism in individuals with rheumatoid arthritis: a preliminary study.
OBJECTIVE
To carry out a pilot study to investigate the effect of short-term oral probiotic administration on the metabolism of sulfasalazine (SSZ) in patients with rheumatoid arthritis (RA) stabilized on SSZ.


METHODS
Twelve subjects with RA taking stable doses of SSZ for a minimum of 3 months prior to the study, received a probiotic preparation contained three strains of bacteria (1.8 x 10(9) CFU/day) twice daily for 1 week. Single point blood and 12-h urine samples were taken before and after probiotic treatment and 3 weeks following discontinuation of probiotics, for determination of SSZ and its metabolites. The presence of the probiotic bacteria in the feces of patients was investigated by denaturing gradient gel electrophoresis (DGGE).


RESULTS
Adverse events recorded were three instances of gastrointestinal disturbance and one flare of RA. Plasma and urinary levels of SSZ and its metabolites showed no statistically significant changes after probiotic administration and the incidence of gastrointestinal disturbance did not appear to be ascribed to higher sulfapyridine plasma levels. Probiotic-specific DGGE bands were detected in the feces of some patients after the treatment period.


CONCLUSIONS
Short-term treatment of RA patients with a multi-strain probiotic did not significantly influence SSZ metabolism as has been demonstrated in animal models.
Lee
Hee Ji
HJ
School of Pharmacy, University of Otago, Dunedin, New Zealand. leehe826@student.otago.ac.nz
Waller
Rosmary D
RD
Stebbings
Simon
S
Highton
John
J
Orlovich
David A
DA
Schmierer
David
D
Fawcett
J Paul
JP
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000097:blood / Q000378:metabolism* / Q000627:therapeutic use* / Q000652:urine; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000382:microbiology; D001644:Bifidobacterium / Q000254:growth & development / Q000378:metabolism; D001711:Biotransformation; D004347:Drug Interactions; D005243:Feces / Q000382:microbiology; D005260:Female; D006801:Humans; D007779:Lactobacillus acidophilus / Q000254:growth & development / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D019936:Probiotics / Q000008:administration & dosage* / Q000009:adverse effects; D013291:Streptococcus / Q000254:growth & development / Q000378:metabolism; D013427:Sulfapyridine / Q000097:blood / Q000652:urine; D012460:Sulfasalazine / Q000009:adverse effects / Q000097:blood / Q000378:metabolism* / Q000627:therapeutic use* / Q000652:urine
D018501:Antirheumatic Agents; D012460:Sulfasalazine; D013427:Sulfapyridine