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Efficacy and safety of non-pharmacological and non-biological pharmacological treatment: A systematic literature review informing the 2016 update of the ASAS/EULAR recommendations for the management of axial spondyloarthritis

2017-01-01Recensão Acesso aberto
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dc.contributor.authorRegel, A.
dc.contributor.authorSepriano, A.
dc.contributor.authorSepriano, Alexandre
dc.contributor.authorBaraliakos, X.
dc.contributor.authorVan Der Heijde, D.
dc.contributor.authorBraun, J.
dc.contributor.authorLandewé, R.
dc.contributor.authorVan Den Bosch, F.
dc.contributor.authorFalzon, L.
dc.contributor.authorRamiro, S.
dc.contributor.authorRamiro, Sofia
dc.contributor.institutionNOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM)
dc.contributor.pblBMJ Publishing Group
dc.date.accessioned2017-10-12T22:02:22Z
dc.date.available2017-10-12T22:02:22Z
dc.date.issued2017-01-01
dc.description.abstractTo assess the efficacy and safety of non-biological therapies in patients with axial spondyloarthritis (axSpA) to inform the update of the Assessment of SpondyloArthritis international Society (ASAS)/European League Against Rheumatism (EULAR) recommendations for the management of axSpA. A systematic literature review (2009-2016) of all non-pharmacological treatments, non-biological drugs (except targeted synthetic disease-modifying antirheumatic drugs (DMARDs)) and surgical therapies was performed. Randomised controlled trials (RCTs) and clinical controlled trials were assessed for efficacy and safety, while observational studies with a comparator were assessed for safety. All relevant efficacy and safety outcomes were included. Study heterogeneity precluded data pooling. If possible, Cohen's effect size was calculated for non-pharmacological treatments. In total, 45 papers and 2 abstracts were included. Studies on non-pharmacological treatments were very heterogeneous but overall confirmed a benefit for regular exercises, with small improvements in disease activity, function and spinal mobility. New studies on non-steroidal anti-inflammatory drugs (NSAIDs) confirmed their efficacy and new safety signals were not found. NSAIDs used continuously compared with on-demand did not reduce the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) mean change over 2 years in patients with ankylosing spondylitis with normal C reactive protein (CRP; ≤ mg/L) (1 'negative' RCT (0.9 vs 0.8; p=0.62)), while for patients with high CRP, conflicting results were found (1 'positive' RCT (0.2 vs 1.7; p=0.003), 1 'negative' RCT (1.68 vs 0.96; p=0.28)). No new trials were found for conventional synthetic DMARDs (csDMARDs). Short-term high-dose systemic glucocorticoids showed limited efficacy. Regular exercises may improve several outcomes. Efficacy and safety of NSAIDs in axSpA are confirmed. Glucocorticoids are not proven to be effective in axSpA and new data on csDMARDs are lacking. © Published by the BMJ Publishing Group Limited.en
dc.description.versionpublishersversion
dc.description.versionpublished
dc.format.extent11
dc.format.extent1490884
dc.identifier.doi10.1136/rmdopen-2016-000397
dc.identifier.issn2056-5933
dc.identifier.otherPURE: 3209529
dc.identifier.otherPURE UUID: 4e8c7bd9-9bb2-4123-95fd-37eed3a508c2
dc.identifier.otherRIS: urn:7C4699513FDEA25F7543C7EC156D19C5
dc.identifier.otherScopus: 85011085601
dc.identifier.otherPubMed: 28176966
dc.identifier.otherPubMedCentral: PMC5278330
dc.identifier.otherWOS: 000443681800022
dc.identifier.urihttps://www.scopus.com/inward/record.uri?eid=2-s2.0-85011085601&doi=10.1136%2frmdopen-2016-000397&partnerID=40&md5=83ab3d08e6f406bfb87d481abddb756e
dc.identifier.urlhttps://www.scopus.com/inward/record.uri?eid=2-s2.0-85011085601&doi=10.1136%2frmdopen-2016-000397&partnerID=40&md5=83ab3d08e6f406bfb87d481abddb756e
dc.language.isoeng
dc.peerreviewedyes
dc.subjectAnkylosing Spondylitis
dc.subjectSpondyloarthritis
dc.subjectTreatment
dc.titleEfficacy and safety of non-pharmacological and non-biological pharmacological treatment: A systematic literature review informing the 2016 update of the ASAS/EULAR recommendations for the management of axial spondyloarthritisen
dc.typereview
degois.publication.firstPage
degois.publication.issue1
degois.publication.lastPage
degois.publication.titleRMD Open
degois.publication.volume3
dspace.entity.typePublication
person.familyNameSepriano
person.familyNameRamiro
person.givenNameAlexandre
person.givenNameSofia
person.identifier397398
person.identifier.ciencia-id5E1B-9976-5CE4
person.identifier.ciencia-idC513-D4F1-EEC3
person.identifier.orcid0000-0003-1954-0229
person.identifier.orcid0000-0002-8899-9087
person.identifier.scopus-author-id55266526300
rcaap.rightsopenAccess
relation.isAuthorOfPublicationd87df0c7-841b-4648-a99e-296348e2e286
relation.isAuthorOfPublication9853406a-2641-440d-a8b1-a516bdb6f32f
relation.isAuthorOfPublication.latestForDiscovery9853406a-2641-440d-a8b1-a516bdb6f32f

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