ORIGINAL ARTICLE Conventional DMARD therapy (methotrexate- sulphasalazine) may decrease the requirement of biologics in routine practice of ankylosing spondylitis patients: A real-life experience Meryem CAN, 1 Sibel Z. AYDIN, 2 Adil NIG ˘ DELIOG ˘ LU, 3 Pamir ATAGU ¨ NDU ¨ Z 1 and Haner DIRESKENELI 1 1 Department of Rheumatology, Pendik Training and Research Hospital, Marmara University, 2 Rheumatology Unit, Istanbul Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey, and 3 Department of Internal Medicine, Pendik Training and Research Hospital, Marmara University, Istanbul, Turkey Abstract Aim: The effect of disease-modifying antirheumatic drugs (DMARDs) in ankylosing spondylitis (AS) is still con- troversial. We aimed to evaluate the efficacy of sulphasalazine (SSZ) mono- or combination therapy with metho- trexate (MTX) in AS patients naive to anti-tumor necrosis factor alpha (TNFa) agents. Methods: Patients with AS (n = 87, male : female, 46 : 41) treated with SSZ (n = 61) or SSZ + MTX (n = 26) combination and a documented 6-month follow-up were evaluated retrospectively. Disease activity was assessed by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), C-reactive protein and erythrocyte sedi- mentation rate. Requirement for anti-TNFa therapy was assessed after 6 months. Results: Mean (SD) age was 43.0 (11.0) versus 40.2 (11.1) and disease duration was 11.0 (8.6) versus 8.2 (5.2) years, in the SSZ and SSZ + MTX groups, respectively. Initially, 59% (34/61) of the patients in SSZ monotherapy and 68% (17/26) in the combination arm had BASDAI > 4. At the end of the study, BASDAI scores decreased similarly in both groups (mono: 1.4 [–7–6] versus combination: 0.7 [–3–6] P = 0.2). BASDAI was > 4 in 32.8% (20/61) of patients in the SSZ monotherapy and in 44% (11/26) in the combination arm. Only 4 (6.6%) patients in the SSZ group and 2 (7.7%) in the ombination arm were switched to anti-TNFa therapies. Discussion: A significant subset of our AS patients responded to SSZ mono or SSZ + MTX combination thera- pies at 6 months follow-up. Using BASDAI, the requirement for biological therapies decreased by 21–24%. In AS patients, including those with axial involvement only, DMARD therapy may be a reasonable first alternative to anti-TNFa therapy and may delay the switch to biologic agents. Key words: ankylosing spondylitis, disease activity, therapy. INTRODUCTION Ankylosing spondylitis (AS), the most common spond- yloarthropathy (SpA), causes chronic back pain and spinal fusion, often resulting in severe disability and increased morbidity. 1 Structural changes such as ero- sions, syndesmophytes and ankylosis are characteristics of AS. These can be quantified by the modified Stokes Anklylosing Spondylitis Spinal Score (mSASSS) which assesses abnormalities in the anterior vertebral corners of the cervical and lumbar spine. 2 Non-steroidal anti-inflammatory drugs (NSAIDs) have been the mainstay of treatment for AS. 3 For those Correspondence: Meryem Can, MD, Marmara University, Department of Rheumatology, Pendik Training and Research Hospital, Pendik, Istanbul, Turkey. Email: meryemkrk@gmail.com © 2012 The Authors International Journal of Rheumatic Diseases © 2012 Asia Pacific League of Associations for Rheumatology and Blackwell Publishing Asia Pty Ltd International Journal of Rheumatic Diseases 2012