Review of the Outcome of the Treatment of NSAID-refractory
Ankylosing Spondylitis (AS) with the Step-down Bridge
Protocol of Intravenous and Oral Combination of 5
Immunosuppressants (SBP-5-IMNs)
Introduction
Myths are ingrained in the community that nothing can be
done for patients with Ankylosing Spondylitis (AS). After
the standard therapy with NSAIDs and physical therapy, the
disease will run its natural course over 3-4 decades. NSAIDs
neither stop or slow the progression of the disease in
NSAID-refractory AS.
Drugs used in AS
Sulfasalazine shows only some variable beneficial effect in
the peripheral joints in the short term. Methotrexate (MTX),
pulse intravenous (IV) Methylprednisolone (MPS) and
Cyclophosphamide (CyP), oral Cyclosporine (CyS) and
Mycophenolate Mofetil (MMF) in single drug therapy show
varying efficacy in the treatment of AS. However,
combination therapy may be required when treating AS with
MTX. No study has reported Remission in the treatment of AS.
The consequences are that myths are entrenched in the
community, medical professionals, and rheumatologists
Myth No. 1 is Remission with whatever therapy is impossible
in AS within months
Myth No. 2 is Remission by oral drugs is not possible in AS
within months
Myth No. 3 is Remission without drug is unheard of in AS.
Myth No. 4 is healing of erosion(s) and termination of
progression of calcification are
unheard of
Myth No. 1 is refuted by the SBP-5-IMNs with Remission
achieved in 2-4 months
Myth No. 2 is refuted by the SBP-5-IMNs with Remission
(RworalDs) achieved in
5.5-7.5 months
Myth No. 3 is refuted by the SBP-5-IMNs with Remission
without Drug (RwD) achieved
In 53.5-55.5 months
Myth No. 4 is refuted by the SBP-5-IMNs with healing of
erosion(s) and termination of
the progression of calcification
How are these outcomes achieved? Click
Clinical outcome
79 patients with NSAID-refractory AS treated with the
SBP-5-IMNs in a 6 years observational study.
BASRI < 2: 87% of NSAID-refractory IMN-naïve AS independent
of disease duration,
achieves Remission without Drug (RwD).
BASRI > 2: 64% of NSAID-refractory IMN-naïve AS independent
of disease duration,
achieves Remission with oral Drugs (RworalDs)
8.0% not IMN-naïve NSAID-refractory AS patients, achieves
improvement of ASAS70
15.2% are dropouts.
Radiological outcome after 6 years of the cases with
Baseline BASRI < 2 becomes BASRI 0 with healing of erosion
and no new erosion
Baseline BASRI > 2 remains in status quo or not
significantly worse compared with baseline with healing of
erosion and new erosion prevented.
With the addition of intravenous 5-Fluorouracil (5FU), the
SBP-5-IMNs becomes
SBP-6-IMNs. To suppress flare, the SBP-6-IMNs is more
effective than the
SBP-5-IMNs, because of IMN-naivity of 5FU, but with similar
adverse effects
AS Alert
: do not let NSAID-refractory AS progress from BASRI < 2 to
BASRI > 2, because RwD cannot be achieved by the SBP-6-IMNs.
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LupusArthritisIndonesia.org - Indonesian Lupus & Arthritis Forum
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