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Related Experiment Videos

Ankylosing spondylitis and current disease-controlling agents: do they work?

Walter P Maksymowych1, Maxime Breban, J Braun

  • 1Department of Medicine, University of Alberta, Edmonton, Alberta, Canada T6G 2S2.

Best Practice & Research. Clinical Rheumatology
|October 31, 2002
PubMed
Summary

Disease modification in ankylosing spondylitis (AS) is unclear. Current trials focus on symptoms, and validated measures for disease modification like spinal mobility are lacking, hindering treatment evaluation.

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Area of Science:

  • Rheumatology
  • Clinical Trial Design

Background:

  • Ankylosing spondylitis (AS) disease modification remains poorly defined, unlike rheumatoid arthritis (RA).
  • Current AS clinical trials predominantly use symptomatic endpoints.
  • Validated measures for disease modification, including spinal mobility and radiological progression, are lacking or insufficiently sensitive in AS.

Purpose of the Study:

  • To clarify the concept of disease modification in ankylosing spondylitis (AS).
  • To evaluate the suitability of current endpoint measures in AS trials for assessing disease modification.

Main Methods:

  • Review of existing clinical trial methodologies and endpoint measures in ankylosing spondylitis (AS).
  • Analysis of the sensitivity and validation status of proposed disease-modifying endpoints.

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Main Results:

  • Standard clinical trial endpoints for AS primarily capture symptomatology.
  • Measures like spinal mobility and radiological progression lack sufficient validation or sensitivity for disease modification assessment.
  • Non-steroidal anti-inflammatory drugs (NSAIDs) offer symptomatic relief but short trial durations limit conclusions on disease modification.
  • Disease-modifying antirheumatic drugs (DMARDs) like sulfasalazine show limited efficacy, primarily in AS patients with peripheral synovitis.
  • Limited data exists for methotrexate's efficacy in AS.

Conclusions:

  • The concept of disease modification in ankylosing spondylitis (AS) requires further clarification.
  • Current endpoint measures in AS trials are inadequate for robustly assessing disease modification.
  • More sensitive and validated outcome measures are needed for future AS clinical trials.