title: Should non-steroidal anti-inflammatory drugs be used continuously in ankylosing spondylitis?
abstract: OBJECTIVE
  The 2010 update of ASAS/EULAR recommendations for managing ankylosing spondylitis (AS) specify that continuous non-steroidal anti-inflammatory drug (NSAID) treatment should be preferred in patients with persistently active, symptomatic disease. Here, our objective was to assess whether continuous NSAID therapy improves disease control and influences radiographic progression compared to on-demand therapy. We also assessed the safety profiles of both regimens.
  
  
  METHODS
  We performed a review by searching the PubMed and Embase databases using two MeSH term combinations to compare continuous and on-demand NSAID therapy in terms of disease control, radiographic progression, and safety.
  
  
  RESULTS
  The only study evaluating the impact of continuous NSAID therapy on disease control showed no significant difference with on-demand therapy. In four studies, continuous treatment was associated with slower radiographic progression, as assessed in three studies using the modified Stoke Ankylosing Spondylitis Spinal Score (m-SASSS). Three studies compared the safety of continuous and on-demand celecoxib, two in osteoarthritis and one in AS, and found no significant differences regarding the usual side effects of Cox-2 inhibitors.
  
  
  CONCLUSIONS
  Several studies showed slower radiographic progression with continuous NSAID therapy in AS. No studies demonstrated superiority of continuous NSAID therapy regarding symptom control. Continuous NSAID therapy (at least with Cox-2 inhibitors) does not modify safety compared to on-demand therapy.
authors.affiliation: Rheumatology department, CHU Cavale-Blanche, Brest University Hospital, boulevard Tanguy-Prigent, 29200 Brest, France.
authors.forename: Dewi
authors.initials: D
authors.lastname: Guellec
authors.affiliation: Rheumatology department, CHU Le-Kremlin-Bicêtre, Le-Kremlin-Bicêtre, France.
authors.forename: Gaëtane
authors.initials: G
authors.lastname: Nocturne
authors.affiliation: Oncology department, centre Jean-Perrin, Clermont-Ferrand, France.
authors.forename: Zuzana
authors.initials: Z
authors.lastname: Tatar
authors.affiliation: Rheumatology department, CHU Sainte-Marguerite, Marseille, France.
authors.forename: Thao
authors.initials: T
authors.lastname: Pham
authors.affiliation: Rheumatology department, Hôpital Saint-Antoine, AP-HP, Pierre-et-Marie-Curie Paris 6 University, Paris, France.
authors.forename: Jérémie
authors.initials: J
authors.lastname: Sellam
authors.affiliation: Rheumatology department, Hôpital Purpan, Toulouse, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Cantagrel
authors.affiliation: Rheumatology department, CHU Cavale-Blanche, Brest University Hospital, boulevard Tanguy-Prigent, 29200 Brest, France. Electronic address: alain.saraux@chu-brest.fr.
authors.forename: Alain
authors.initials: A
authors.lastname: Saraux
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D018450:Disease Progression; D004334:Drug Administration Schedule; D006801:Humans; D061214:Patient Safety; D011859:Radiography; D013167:Spondylitis, Ankylosing / Q000000981:diagnostic imaging / Q000188:drug therapy*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal
keywords: Ankylosing spondylitis; Disease progression; Drug administration schedule; Systematic review