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da Cruz Lage R, Marques CDL, Oliveira TL, Resende GG, Kohem CL, Saad CG, Ximenes AC, Gonçalves CR, Bianchi WA, de Souza Meirelles E, Keiserman MW, Chiereghin A, Campanholo CB, Lyrio AM, Schainberg CG, Pieruccetti LB, Yazbek MA, Palominos PE, Goncalves RSG, Assad RL, Bonfiglioli R, Lima SMAAL, Carneiro S, Azevedo VF, Albuquerque CP, Bernardo WM, Sampaio-Barros PD, de Medeiros Pinheiro M. Brazilian recommendations for the use of nonsteroidal anti-inflammatory drugs in patients with axial spondyloarthritis. Adv Rheumatol 2021; 61:4. [PMID: 33468245 DOI: 10.1186/s42358-020-00160-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 12/29/2020] [Indexed: 01/04/2023] Open
Abstract
Spondyloarthritis (SpA) is a group of chronic inflammatory systemic diseases characterized by axial and/or peripheral joints inflammation, as well as extra-articular manifestations. Over some decades, nonsteroidal anti-inflammatory drugs (NSAIDs) have been the basis for the pharmacological treatment of patients with axial spondyloarthritis (axSpA). However, the emergence of the immunobiologic agents brought up the discussion about the role of NSAIDs in the management of these patients. The objective of this guideline is to provide recommendations for the use of NSAIDs for the treatment of axSpA. A panel of experts from the Brazilian Society of Rheumatology conducted a systematic review and meta-analysis of randomized clinical trials for 15 predefined questions. The Grading of Recommendations, Assessment, Development and Evaluation methodology to assess the quality of evidence and formulate recommendations were used, and at least 70% agreement of the voting panel was needed. Fourteen recommendations for the use of NSAIDs in the treatment of patients with axSpA were elaborated. The purpose of these recommendations is to support clinicians' decision making, without taking out his/her autonomy when prescribing for an individual patient.
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Affiliation(s)
- Ricardo da Cruz Lage
- Universidade Federal de Minas Gerais (UFMG), Alameda Álvaro Celso 175, Ambulatório Bias Fortes, 2° andar, Belo Horizonte, MG, 30150-260, Brazil.
| | | | | | - Gustavo Gomes Resende
- Universidade Federal de Minas Gerais (UFMG), Alameda Álvaro Celso 175, Ambulatório Bias Fortes, 2° andar, Belo Horizonte, MG, 30150-260, Brazil
| | | | | | | | | | | | | | | | - Adriano Chiereghin
- Pontifícia Universidade Católica (PUC) de Sorocaba, Sorocaba, SP, Brazil
| | | | - André Marun Lyrio
- Pontifícia Universidade Católica (PUC) de Campinas, Campinas, SP, Brazil
| | | | | | | | | | | | | | - Rubens Bonfiglioli
- Pontifícia Universidade Católica (PUC) de Campinas, Campinas, SP, Brazil
| | | | - Sueli Carneiro
- Universidade Federal do Rio De Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
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Kroon FPB, van der Burg LRA, Ramiro S, Landewé RBM, Buchbinder R, Falzon L, van der Heijde D. Nonsteroidal Antiinflammatory Drugs for Axial Spondyloarthritis: A Cochrane Review. J Rheumatol 2016; 43:607-17. [PMID: 26834216 DOI: 10.3899/jrheum.150721] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2015] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To determine the benefits and harms of nonsteroidal antiinflammatory drugs (NSAID) in axial spondyloarthritis (axSpA). METHODS Systematic review using Cochrane Collaboration methodology. INCLUSION CRITERIA randomized controlled trials (RCT) and quasi-RCT (to June 2014), investigating NSAID versus any control for axSpA, and observational studies of longterm effects (≥ 6 mos) of NSAID on radiographic progression or adverse events. Main outcomes were pain, Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Functional Index, Bath Ankylosing Spondylitis Metrology Index, radiographic progression, number of withdrawals because of adverse events, and number of serious adverse events. Risk of bias was assessed. RESULTS Thirty-five RCT, 2 quasi-RCT, and 2 cohort studies were included. Twenty-nine RCT and 2 quasi-RCT (n = 4356) were included in pooled analyses [traditional NSAID vs placebo (n = 5), cyclooxygenase-2 (COX-2) vs placebo (n = 3), COX-2 vs traditional NSAID (n = 4), NSAID vs NSAID (n = 24), naproxen vs other NSAID (n = 3), and low- vs high-dose NSAID (n = 5)]. Compared with placebo, both traditional and COX-2 NSAID were consistently more efficacious at 6 weeks and equally safe after 12 weeks. No significant differences in benefits or harms between the 2 NSAID classes and no important differences in benefits or withdrawals because of adverse events between different NSAID were found, especially if studies with high risk of bias were excluded. Single studies suggest NSAID may retard radiographic progression, especially by continuous rather than on-demand NSAID use. CONCLUSION High-quality evidence indicates that both traditional and COX-2 NSAID are efficacious for treating axSpA, and harms are not different from placebo in the short term. Various NSAID are equally effective.
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Affiliation(s)
- Féline P B Kroon
- From the Department of Rheumatology, and Department of Gastroenterology, Leiden University Medical Center, Leiden; Department of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam, Amsterdam; Department of Rheumatology, Atrium Medical Center, Heerlen, the Netherlands; Monash Department of Clinical Epidemiology, Cabrini Hospital, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern, Australia; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, New York, USA.F.P. Kroon, MD, Department of Rheumatology, Leiden University Medical Center; L.R. van der Burg, MD, Department of Gastroenterology, Leiden University Medical Center; S. Ramiro, MD, PhD, Department of Rheumatology, Leiden University Medical Center, and Department of Internal Medicine, Rijnland Medical Center; R.B. Landewé, MD, PhD, Professor, Department of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam, and Department of Rheumatology, Atrium Medical Center; R. Buchbinder, MBBS (Hons), PhD, Professor, Monash Department of Clinical Epidemiology, Cabrini Hospital, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; L. Falzon, MD, PhD, Center for Behavioral Cardiovascular Health, Columbia University Medical Center; D. van der Heijde, MD, PhD, Professor, Department of Rheumatology, Leiden University Medical Center.
| | - Lennart R A van der Burg
- From the Department of Rheumatology, and Department of Gastroenterology, Leiden University Medical Center, Leiden; Department of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam, Amsterdam; Department of Rheumatology, Atrium Medical Center, Heerlen, the Netherlands; Monash Department of Clinical Epidemiology, Cabrini Hospital, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern, Australia; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, New York, USA.F.P. Kroon, MD, Department of Rheumatology, Leiden University Medical Center; L.R. van der Burg, MD, Department of Gastroenterology, Leiden University Medical Center; S. Ramiro, MD, PhD, Department of Rheumatology, Leiden University Medical Center, and Department of Internal Medicine, Rijnland Medical Center; R.B. Landewé, MD, PhD, Professor, Department of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam, and Department of Rheumatology, Atrium Medical Center; R. Buchbinder, MBBS (Hons), PhD, Professor, Monash Department of Clinical Epidemiology, Cabrini Hospital, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; L. Falzon, MD, PhD, Center for Behavioral Cardiovascular Health, Columbia University Medical Center; D. van der Heijde, MD, PhD, Professor, Department of Rheumatology, Leiden University Medical Center
| | - Sofia Ramiro
- From the Department of Rheumatology, and Department of Gastroenterology, Leiden University Medical Center, Leiden; Department of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam, Amsterdam; Department of Rheumatology, Atrium Medical Center, Heerlen, the Netherlands; Monash Department of Clinical Epidemiology, Cabrini Hospital, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern, Australia; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, New York, USA.F.P. Kroon, MD, Department of Rheumatology, Leiden University Medical Center; L.R. van der Burg, MD, Department of Gastroenterology, Leiden University Medical Center; S. Ramiro, MD, PhD, Department of Rheumatology, Leiden University Medical Center, and Department of Internal Medicine, Rijnland Medical Center; R.B. Landewé, MD, PhD, Professor, Department of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam, and Department of Rheumatology, Atrium Medical Center; R. Buchbinder, MBBS (Hons), PhD, Professor, Monash Department of Clinical Epidemiology, Cabrini Hospital, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; L. Falzon, MD, PhD, Center for Behavioral Cardiovascular Health, Columbia University Medical Center; D. van der Heijde, MD, PhD, Professor, Department of Rheumatology, Leiden University Medical Center
| | - Robert B M Landewé
- From the Department of Rheumatology, and Department of Gastroenterology, Leiden University Medical Center, Leiden; Department of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam, Amsterdam; Department of Rheumatology, Atrium Medical Center, Heerlen, the Netherlands; Monash Department of Clinical Epidemiology, Cabrini Hospital, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern, Australia; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, New York, USA.F.P. Kroon, MD, Department of Rheumatology, Leiden University Medical Center; L.R. van der Burg, MD, Department of Gastroenterology, Leiden University Medical Center; S. Ramiro, MD, PhD, Department of Rheumatology, Leiden University Medical Center, and Department of Internal Medicine, Rijnland Medical Center; R.B. Landewé, MD, PhD, Professor, Department of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam, and Department of Rheumatology, Atrium Medical Center; R. Buchbinder, MBBS (Hons), PhD, Professor, Monash Department of Clinical Epidemiology, Cabrini Hospital, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; L. Falzon, MD, PhD, Center for Behavioral Cardiovascular Health, Columbia University Medical Center; D. van der Heijde, MD, PhD, Professor, Department of Rheumatology, Leiden University Medical Center
| | - Rachelle Buchbinder
- From the Department of Rheumatology, and Department of Gastroenterology, Leiden University Medical Center, Leiden; Department of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam, Amsterdam; Department of Rheumatology, Atrium Medical Center, Heerlen, the Netherlands; Monash Department of Clinical Epidemiology, Cabrini Hospital, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern, Australia; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, New York, USA.F.P. Kroon, MD, Department of Rheumatology, Leiden University Medical Center; L.R. van der Burg, MD, Department of Gastroenterology, Leiden University Medical Center; S. Ramiro, MD, PhD, Department of Rheumatology, Leiden University Medical Center, and Department of Internal Medicine, Rijnland Medical Center; R.B. Landewé, MD, PhD, Professor, Department of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam, and Department of Rheumatology, Atrium Medical Center; R. Buchbinder, MBBS (Hons), PhD, Professor, Monash Department of Clinical Epidemiology, Cabrini Hospital, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; L. Falzon, MD, PhD, Center for Behavioral Cardiovascular Health, Columbia University Medical Center; D. van der Heijde, MD, PhD, Professor, Department of Rheumatology, Leiden University Medical Center
| | - Louise Falzon
- From the Department of Rheumatology, and Department of Gastroenterology, Leiden University Medical Center, Leiden; Department of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam, Amsterdam; Department of Rheumatology, Atrium Medical Center, Heerlen, the Netherlands; Monash Department of Clinical Epidemiology, Cabrini Hospital, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern, Australia; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, New York, USA.F.P. Kroon, MD, Department of Rheumatology, Leiden University Medical Center; L.R. van der Burg, MD, Department of Gastroenterology, Leiden University Medical Center; S. Ramiro, MD, PhD, Department of Rheumatology, Leiden University Medical Center, and Department of Internal Medicine, Rijnland Medical Center; R.B. Landewé, MD, PhD, Professor, Department of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam, and Department of Rheumatology, Atrium Medical Center; R. Buchbinder, MBBS (Hons), PhD, Professor, Monash Department of Clinical Epidemiology, Cabrini Hospital, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; L. Falzon, MD, PhD, Center for Behavioral Cardiovascular Health, Columbia University Medical Center; D. van der Heijde, MD, PhD, Professor, Department of Rheumatology, Leiden University Medical Center
| | - Désirée van der Heijde
- From the Department of Rheumatology, and Department of Gastroenterology, Leiden University Medical Center, Leiden; Department of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam, Amsterdam; Department of Rheumatology, Atrium Medical Center, Heerlen, the Netherlands; Monash Department of Clinical Epidemiology, Cabrini Hospital, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern, Australia; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, New York, USA.F.P. Kroon, MD, Department of Rheumatology, Leiden University Medical Center; L.R. van der Burg, MD, Department of Gastroenterology, Leiden University Medical Center; S. Ramiro, MD, PhD, Department of Rheumatology, Leiden University Medical Center, and Department of Internal Medicine, Rijnland Medical Center; R.B. Landewé, MD, PhD, Professor, Department of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam, and Department of Rheumatology, Atrium Medical Center; R. Buchbinder, MBBS (Hons), PhD, Professor, Monash Department of Clinical Epidemiology, Cabrini Hospital, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; L. Falzon, MD, PhD, Center for Behavioral Cardiovascular Health, Columbia University Medical Center; D. van der Heijde, MD, PhD, Professor, Department of Rheumatology, Leiden University Medical Center
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