Sulfasalazine treatment for rheumatoid arthritis: A metaanalysis of 15 randomized trials

Objective. To assess the efficacy and safety of sulfasalazine (SSZ) compare d to placebo and other disease modifying drugs. Methods. A metaanalysis was performed on 15 randomized clinical trials of r heumatoid arthritis (RA) that included SSZ (3 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 3 gold sodium thiomalate or aurothio glucose (GST) (25 mg, 1 g/wk). Results. Compared to PL, SSZ was superior for improvement in erythrocyte se dimentation rate (ESR) (SSZ 37%, PL 14%; p < 0.0001), morning stiffness dur ation (SSZ 61%, PL 33%; p = 0.008), pain visual analog scale (SZ 42%, PL 15 %; p < 0.0001), articular index (SSZ 46%, PL 20%; p < 0.0001), number of sw ollen joints (SSZ 51%, PL 26%; p < 0.0001). number of painful joints (SSZ 5 9%, 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 inc reased (SSZ 24%, PL 7%; p < 0.0001). but lack of efficacy dropouts were dec reased (SSZ 8%, PL 21%; p < 0.0001). Compared to HCQ, SSZ tended to have fe wer 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 signif icantly 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 tende d to complete treatment taking SSZ (SSZ 69%, GST 61%; p = 0.09). Conclusion. Over all, the metaanalysis provides data that support the effec tiveness of SSZ as a treatment for RA.