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Sulfasalazine for treating rheumatoid arthritis

Sulfasalazine has become a common second line drug (DMARD) for the treatment of rheumatoid arthritis (RA).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Sulfasalazine for ankylosing spondylitis

We conducted a review of the effect of sulfasalazine for people with ankylosing spondylitis. After searching for all relevant studies up to November 2013, we found 11 studies involving 895 people. Our findings are summarised below.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

A meta-analysis of balsalazide, mesalazine and sulphasalazine in the treatment of active ulcerative colitis

Bibliographic details: Zhang Z F, Duan Z J, Zhao G, Liu L N, Wang Y D.  A meta-analysis of balsalazide, mesalazine and sulphasalazine in the treatment of active ulcerative colitis. World Chinese Journal of Digestology 2008; 16(30): 3464-3468

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2008

Efficacy and safety of mesalazine versus sulfasalazine for ulcerative colitits: a systematic review

Bibliographic details: Liu RM, Wu B, Zhao YJ, Tang Y.  Efficacy and safety of mesalazine versus sulfasalazine for ulcerative colitits: a systematic review. Chinese Journal of Evidence-Based Medicine 2011; 11(2): 181-186 Available from: http://www.cjebm.org.cn/oa/DArticle.aspx?type=view&id=201102012

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

Leflunomide for the treatment of rheumatoid arthritis

‐ Leflunomide probably improves pain.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Interventions for treating psoriatic arthritis

It has been estimated that arthritis occurs in 5‐7 % of those with psoriasis, which can cause substantial disability in some patients.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Curcumin for maintenance of remission in ulcerative colitis

Curcumin is a natural anti‐inflammatory agent that is often used in many chronic inflammatory conditions including rheumatoid arthritis, esophagitis and post‐surgical inflammation. The purpose of this systematic review was to examine the effectiveness and safety of curcumin therapy for the maintenance of remission in patients with ulcerative colitis (UC), a chronic inflammatory condition of the colon. Currently available agents for the management of this condition have been reported to result side effects, particularly when used for prolonged periods. This review includes one randomized trial with a total of 89 participants. All patients received treatment with sulfasalazine or mesalamine (drugs containing 5‐aminosalicylic acid). Fewer patients in the curcumin group relapsed at six months compared to patients who received placebo (e.g. fake drug). However, this result was not statistically significant. Patients in the curcumin group had significantly lower disease activity index and endoscopic index scores at six months than patients in the placebo group. No serious side effects were reported. A total of nine mild side effects were reported in seven patients. These side effects included a sensation of abdominal bulging, nausea, a brief increase in blood pressure, and a brief increase in the number of stools. The results of this systematic review suggest that curcumin may be a safe and effective therapy for maintenance of remission in ulcerative colitis when given as additional therapy with mesalamine or sulfasalazine. Further research is needed to confirm any possible benefit of curcumin for maintenance therapy in ulcerative colitis.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Azathioprine and 6‐mercaptopurine for maintenance of remission in ulcerative colitis

Studies of azathioprine and 6‐mercaptopurine for maintenance treatment of ulcerative colitis.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Oral 5‐aminosalicylic acid drugs for maintenance of medically‐induced remission in Crohn's disease

Crohn's disease is a chronic inflammatory disorder that can involve any part of the gastrointestinal tract. It can affect people of any age. When people have active Crohn's disease they experience symptoms such as abdominal pain, diarrhoea and weight loss. When symptoms stop, people are considered to be in remission. Active Crohn's disease can be treated by medical therapy (e.g. drugs such as steroids, immunosuppressives or biologics) or by surgery to removed the diseased portions of the intestine. The goal of medical therapy of Crohn's disease is to induce remission and to maintain this remission for as long as possible.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Aminosalicylates for treatment of active Crohn's disease

Crohn's disease is a chronic inflammatory disease of the intestines. Although Crohn's disease is often found in the ileum (the lower part of the small intestine), it can occur in any part of the digestive tract, from the mouth to the anus. The most common symptoms of Crohn's disease are diarrhea and abdominal pain which often occurs in the lower right region of the abdomen.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Oral 5‐aminosalicylic acid for the treatment of active ulcerative colitis

Sulfasalazine (SASP) has been used for treating ulcerative colitis for decades. SASP is made up of 5‐aminosalicylic acid (5‐ASA) linked to a sulfur molecule. Up to a third of patients treated with SASP have reported side effects, which are thought to be related to the sulfur part of the molecule. Common side effects associated with SASP include nausea, indigestion, headache, vomiting and abdominal pain. 5‐ASA drugs were developed to avoid the side effects associated with SASP. This review includes 53 randomized trials with a total of 8548 participants. Oral 5‐ASA was found to be more effective than placebo (fake drug). Although oral 5‐ASA drugs are effective for treating active ulcerative colitis, they are no more effective than SASP therapy. Patients taking 5‐ASA are less likely to experience side effects than patients taking SASP. Side effects associated with 5‐ASA are generally mild in nature, and common side effects include gastrointestinal symptoms (e.g. flatulence, abdominal pain, nausea, and diarrhea), headache and worsening ulcerative colitis. Male infertility is associated with SASP and not with 5‐ASA, so 5‐ASA may be preferred for patients concerned about fertility. 5‐ASA compounds are more expensive than SASP, so SASP may be the preferred option where cost is an important factor. 5‐ASA dosed once daily appears to be as effective and safe as conventionally dosed (two or three times daily) 5‐ASA. There do not appear to be any differences in effectiveness or safety among the various 5‐ASA formulations. A daily dosage of 2.4 g appears to be a safe and effective therapy for patients with mild to moderately active ulcerative colitis. Patients with moderate disease may benefit from an initial dose of 4.8 g/day.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Oral 5‐ASA compounds for maintaining remission in ulcerative colitis

Sulfasalazine (SASP) has been used for treating ulcerative colitis for decades. SASP is made up of 5‐aminosalicylic acid (5‐ASA) linked to a sulfur molecule. Up to a third of patients treated with SASP have reported side effects, which are thought to be related to the sulfur part of the molecule. Common side effects associated with SASP include nausea, indigestion, headache, vomiting and abdominal pain. 5‐ASA drugs were developed to avoid the side effects associated with SASP. This review includes 41 randomized trials with a total of 8928 participants. Oral 5‐ASA was found to be more effective than placebo (fake drug) for maintaining remission. Although oral 5‐ASA preparations are effective for maintaining remission in ulcerative colitis, they are no more effective than sulfasalazine (SASP) therapy. People who have become well can remain so by continuing to take either medication. There is no evidence that side effects are more frequent with one or the other medication. However, the side effects of 5‐ASA may be notably less than those associated with SASP therapy. Common side effects associated with 5‐ASA included flatulence, abdominal pain, nausea, diarrhea, headache, dyspepsia (indigestion), and nasopharyngitis (inflammation of the nasal passages). Most of the trials comparing 5‐ASA with SASP enrolled patients who were known to tolerate SASP. This may have reduced SASP‐related side effects in these trials. Male infertility is associated with SASP and not with 5‐ASA, so 5‐ASA may be preferred for patients concerned about fertility. 5‐ASA therapy is more expensive than SASP, so SASP may be the preferred option where cost is an important factor. Oral 5‐ASA administered once daily is as effective and safe as conventional dosing (two or three times daily) for maintaining remission in ulcerative colitis. There does not appear to be any difference in efficacy or safety between the various formulations of 5‐ASA. Patients with extensive ulcerative colitis or with frequent relapses may benefit from a higher dose of maintenance therapy. High dose therapy appears to be as safe as low dose and is not associated with a higher incidence of side effects.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Methotrexate in combination with sulfasalazine is more effective in rheumatoid arthritis patients who failed sulfasalazine than in patients naive to both drugs

This review of combined methotrexate/sulfasalazine therapy for rheumatoid arthritis compared with either agent alone concluded that combination therapy may benefit patients who did not respond to sulfasalazine, but not patients naive to either drug. The conclusions appear to reflect the results, but their reliability is unclear due to potential biases in the review process and the limited synthesis of results.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2009

A meta-analysis of the efficacy of sulfasalazine in comparison with 5-aminosalicylates in the induction of improvement and maintenance of remission in patients with ulcerative colitis

This review concluded that there was no difference in the efficacy and tolerability of sulfasalazine compared to mesalamine or olsalazine for treatment of ulcerative colitis. Withdrawal due to adverse events was lower with balsalazide than sulfasalazine confident, but conclusions could not be made that balsalazide was better. The authors’ conclusions were appropriate, but potentially important clinical differences were not considered.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2009

Efficacy of 5-aminosalicylates in Crohn's disease: systematic review and meta-analysis

OBJECTIVES: Crohn's disease (CD) is a chronic inflammatory disorder of the gastrointestinal tract. Evidence for treatment with 5-aminosalicylic acid (5-ASA) drugs is conflicting. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to examine this issue.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

Systematic evaluation of methotrexate therapy and triple therapy for rheumatoid arthritis

Bibliographic details: Zhang L, Shawutali N, Badelhan A, Yang KH, Tangkejie W, Huang Y, Jielile J.  Systematic evaluation of methotrexate therapy and triple therapy for rheumatoid arthritis. Chinese Journal of Tissue Engineering Research 2013; 17(52): 9049-9054

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Pharmacological treatment of ankylosing spondylitis: a systematic review

The purpose of this study was to review the evidence regarding the efficacy and safety of pharmacological therapies currently available for the treatment of ankylosing spondylitis (AS).A literature search using MEDLINE from 1966 through to April 2005 and a hand search of abstracts from the American College of Rheumatology (ACR) meetings for 2001 through to 2004 were performed. References of articles retrieved were also searched. The MEDLINE search yielded 570 citations and 157 abstracts from ACR were identified. Eighty-four studies were randomised controlled trials (RCTs); 53 fulfilled the inclusion criteria (pharmacological treatment of AS and RCT) and were included in this review. Statistical pooling of data was not performed because of the disparate outcome measures used. Eight RCTs found nonselective NSAIDs and two RCTs found cyclo-oxygenase (COX)-2-selective NSAIDs to be superior to placebo for relief of pain and improvement in physical function. Twenty-nine RCTs showed comparable efficacy and safety between nonselective NSAIDs. One RCT showed no difference between methylprednisolone 1g and 375 mg. Seven RCTs assessing the efficacy of sulfasalazine (sulphasalazine) and two RCTs of methotrexate provided contradictory evidence as to their benefit for treatment of AS. One RCT showed intravenous pamidronate 60 mg to be more effective than 10mg intravenously for the treatment of axial pain. All six RCTs of anti-tumour necrosis factor (TNF)-alpha agents demonstrated superiority to placebo for the treatment of axial and peripheral symptoms. Nonselective as well as COX-2-selective NSAIDs can be used for pain control in patients with AS. Other proven treatment options include sulfasalazine for the treatment of peripheral joint symptoms, while limited evidence supports the use of pamidronate or methotrexate, which require further studies. Anti-TNFalpha agents have been found very effective for the treatment of both peripheral and axial symptoms in patients with AS, but their use is limited by cost and uncertainty over long-term efficacy and safety.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2005

Efficacy of 5-aminosalicylates in ulcerative colitis: systematic review and meta-analysis

OBJECTIVES: The efficacy of 5-aminosalicylic acids (5-ASAs) in ulcerative colitis (UC) has been studied previously in meta-analyses. However, several randomized controlled trials (RCTs) have been published recently, and no previous meta-analysis has studied the effect of 5-ASA dosage used.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

Medicines for Rheumatoid Arthritis: A Review of the Research for Adults

This summary will tell you about two types of medicine to treat RA: DMARDs and corticosteroids. It will explain what research has found about how well DMARDs work when taken alone or with corticosteroids to treat RA. It will also tell you what research says about the side effects of these medicines. You can use this summary to talk with your doctor about whether one of these medicines may be right for you.

Comparative Effectiveness Review Summary Guides for Consumers [Internet] - Agency for Healthcare Research and Quality (US).

Version: November 20, 2012

A systematic review and meta-analysis of efficacy and toxicity of disease modifying anti-rheumatic drugs and biological agents for psoriatic arthritis

This review concluded that gold, sulfasalazine, leflunomide and tumour necrosis factor inhibitors are effective in treating psoriatic arthritis compared to controls, but toxicity was greater. Given the methodological differences between included studies, and limitations in the reporting of the review, such as inconsistencies between the conclusions and statistical analysis, the reliability of the authors' conclusions is uncertain .

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2008

Systematic Reviews in PubMed

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Systematic Review Methods in PubMed

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