Background Biological DMARDs have been widely used in the treatment of ankylosing spondylitis (AS) in the last two decades, but non-steroidal anti-inflammatory drugs (NSAIDs) still serve as the cornerstone in the treatment of AS. Given the wide use of Acemetacin in AS and relative lack of clinical evidence on the selection of NSAIDs in the treatment of AS, the investigation on Acemetacin treating AS is of great significance.
Objective To investigate the effectiveness and safety of Acemetacin in the treatment of AS.
Methods Data on efficacy and safety in 1 115 patients from the Chinese Ankylosing Spondylitis Imaging Cohort (CASPIC) were collected by the Smart-phone SpondyloArthritis Management System (SpAMS). From June 2016 to September 2019, patients admitted to the Department of Rheumatology and Immunology, the First Medical Center of Chinese PLA General Hospital were divided into Acemetacin group and other NSAIDs group according to the medication type. Physician-reported assessments (PGA), overall back pain, nocturnal back pain, AS disease activity score (ASDAS), Bath AS functional index (BASFI), C-reactive protein (CRP) and adverse events at baseline, 3 and 6 months after treatment were compared between the two groups.
Results Totally 1 115 patients with AS were registered, of whom 992 were treated with Acemetacin and 123 were treated with other NSAIDs. There were no significant differences in baseline data between the two groups. The results showed that total back pain and BASFI were significantly improved after three-month treatment of Acemetacin, while comparing to other NSAIDs (P=0.027 and 0.015, respectively). After six-month treatment, patients taking Acemetacin showed greater improvement in PGA (P=0.013), total back pain (P=0.049), nocturnal back pain (P=0.047), BASFI (P=0.042), ASDAS (P=0.007) and CRP (P=0.032) compared to those taking other NSAIDs. During the follow-up periods, no serious adverse event was reported. Mild abnormal liver function occurred in 9 patients treated with Acemetacin and in 6 patients treated with other NSAIDs.
Conclusion Acemetacin shows better efficacy in the treatment of ankylosing spondylitis comparing with other NSAIDs.
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