Efficacy and Safety of Mesalazine (Salofalk®) in an Open Study of 20 Patients with Ankylosing Spondylitis

J. CHRISTIAAN van DENDEREN, IRENE E. van der HORST-BRUINSMA, P. DICK BEZEMER, and BEN A.C. DIJKMANS

ABSTRACT.

Objective. Mesalazine (Salofalk^®) was found to be effective and showed low toxicity in patients with inflammatory bowel disease. The association of gut lesions and spondyloarthropathy (SpA) is well known and we studied the efficacy and safety of a relatively high dose of mesalazine in patients with ankylosing spondylitis (AS).

Methods. In an open study, mesalazine (3–4 g/day) was prescribed for 24 weeks to 20 patients (aged 18–70 yrs) with active AS, defined as the presence of at least one clinical criterion (morning stiffness > 30 min, peripheral synovitis, enthesopathy, or pain score > 2 on a visual analog scale of 10 cm) and one laboratory criterion [erythrocyte sedimentation rate (ESR) > 20 mm/h or C-reactive protein (CRP) > 20 mg/l]. Data on toxicity and disease activity variables (ESR, CRP, BASDAI, BASFI, BASMI, global assessment, and joint count) were obtained at baseline and after 4, 12, and 24 weeks, and analyzed on an intention-to-treat basis.

Results. Study patients had a mean age of 41 years, with mean disease duration of 7.9 years and a mean ESR at baseline of 29 mm/h. After a mean of 9.3 weeks (range 2–22), 8 of the 20 patients prematurely stopped the medication because of adverse effects, mainly gastrointestinal complaints. Twelve patients completed the 24 weeks of the study using a mean dose of 3.2 g/day (range 1–4) mesalazine. Analysis of the data showed improvement in ESR, CRP, and physician's global assessment, but only the change in ESR (29 mm/h on baseline and 25 mm/h at week 24) reached statistical significance (p = 0.03). No change was observed in the other disease activity variables.

Conclusion. No significant improvement in any disease activity variable of active AS was observed during treatment with Salofalk^® except for the ESR. Many side effects were seen. (J Rheumatol 2003;30:1558-60)

Key Indexing Terms:

ANKYLOSING SPONDYLITIS
MESALAZINE

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From the Jan van Breemen Instituut and the Departments of Rheumatology and Epidemiology and Biostatistics, Vrije Universiteit Medical Center, Amsterdam, The Netherlands.

Supported by Tramedico, The Netherlands.

J.C. van Denderen, MD, Jan van Breemen Instituut; I.E. van der Horst-Bruinsma, MD, PhD, Department of Rheumatology; P.D. Bezemer, PhD, Department of Epidemiology and Biostatistics, Vrije Universiteit Medical Center; B.A.C. Dijkmans, MD, PhD, Jan van Breemen Instituut, and the Department of Rheumatology, Vrije Universiteit Medical Center.

Address reprint requests to Dr I.E. van der Horst-Bruinsma, Vrije Universiteit Medical Center, Department of Rheumatology 4A-42, PO Box 7057, 1007 MB Amsterdam, The Netherlands. E-mail: secr.reumatologie@azvu.nl

Submitted July 4, 2002; revision accepted November 20, 2002.

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