title: Is there a role for sulphasalazine in axial  spondyloarthritis in the era of TNF inhibition?  Data from the NOR-DMARD longitudinal  observational study.
abstract: OBJECTIVE
  The objectives of this study were to characterize patients with predominantly axial SpA who received SSZ as their first DMARD, compare the response to treatment in patients with and without peripheral disease and identify predictors of discontinuation of SSZ. We also investigated response to TNF inhibitor (TNFi) after SSZ failure.
  
  
  METHODS
  We included DMARD-naive patients with predominantly axial SpA starting SSZ or TNFi treatment from a Norwegian, multicentre longitudinal observational study (NOR-DMARD). In patients starting SSZ, we compared the 3-month responses between patients with and without swollen joints and identified predictors of discontinuation by Cox regression analysis. Sixty-six SSZ-treated patients later switched to a TNFi, and we compared their 3-month responses and drug survival to patients starting a TNFi as their first DMARD.
  
  
  RESULTS
  Patients receiving SSZ (n = 181) as their first DMARD had shorter disease duration, were more frequently female and had more swollen joints than those starting TNFi (n = 543). There was a trend toward better 3-month responses to SSZ in patients with peripheral joint swelling, and they had significantly better 3-year drug survival than patients without swollen joints at baseline. Predictors of SSZ discontinuation were no peripheral joint swelling, higher CRP and higher BASDAI back pain score. TNFi response was similar in patients previously treated with SSZ, as in DMARD-naive patients.
  
  
  CONCLUSIONS
  Our findings support current recommendations of SSZ as an optional treatment in SpA patients with peripheral disease, although overall responses were modest. Initial treatment with SSZ does not seem to impair later TNFi response.
authors: Karen M
authors: KM
authors: Fagerli
authors: Désirée
authors: D
authors: van der Heijde
authors: Marte S
authors: MS
authors: Heiberg
authors: Ada
authors: A
authors: Wierød
authors: Synøve
authors: S
authors: Kalstad
authors: Erik
authors: E
authors: Rødevand
authors: Knut
authors: K
authors: Mikkelsen
authors: Tore K
authors: TK
authors: Kvien
authors: Elisabeth
authors: E
authors: Lie
mesh_terms: D000328:Adult; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001688:Biological Products / Q000627:therapeutic use; D057915:Drug Substitution; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D025241:Spondylarthritis / Q000188:drug therapy*; D012460:Sulfasalazine / Q000627:therapeutic use*; D017211:Treatment Failure; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D018501:Antirheumatic Agents; D001688:Biological Products; D014409:Tumor Necrosis Factor-alpha; D012460:Sulfasalazine