Treatment of ankylosing spondylitis with flurbiprofen or phenylbutazone

Abstract

Flurbiprofen (150-200 mg daily) and phenylbutazone (300-400 mg daily) were compared in the management of 27 patients with active ankylosing spondylitis. This was a parallel, double-blind, and randomized trial of 6 weeks duration. Both drugs were equally effective in the relief of pain and tenderness of the affected joints. Overall subjective improvement, assessed by the patient and the investigator at the end of the trial, favored phenylbutazone, but it did not reach a statistically significant level. The mean values of the endpoint parameters of spinal motion showed statistically significant improvement in both groups, except in the Schober test in the flurbiprofen group and chest expansion in the phenylbutazone group. Untoward effects characteristic of these drugs were found in a few patients.

Ankylosing spondylitis: an overview

“…34-36 48 Equivalency with phenylbutazone is represented by the results of a double blind, randomised, six week comparative study of 27 patients with active AS, which found flurbiprofen (150-200 mg/day) to be as effective as phenylbutazone (300-400 mg/day) in relieving pain and tenderness of affected joints. 34 Both treatments also produced significant improvement in end point parameters of spinal motion (except in the Schöber test in the flurbiprofen group and chest expansion in the phenylbutazone group). Similarly, a 12 week, randomised, double blind trial that included a 36 week open extension phase demonstrated that diflunisal (1000 mg/day) and phenylbutazone (400 mg/day) were equally effective in providing sustained relief of AS symptoms.…”

“…33 Phenylbutazone was subsequently introduced into clinical practice in 1949 and became the first drug for which the term non-steroidal anti-inflammatory drug (NSAID) was applied. Although it was highly effective in controlling pain and inflammation, [34][35][36] phenylbutazone was found to cause serious side effects, notably aplastic anaemia and hepatic injury, which were sometimes fatal. 37 38 Thus, phenylbutazone was replaced by newer NSAIDs with improved safety profiles as first line drug treatment in AS.…”

Nonsteroidal Antiinflammatory Drugs for Axial Spondyloarthritis: A Cochrane Review

“…A detailed description of the search results and characteristics of included studies can be found in the original publication 22 . We initially identified 7883 records; 177 qualified for full review and 39 were finally included in this review (Figure 1) [38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67][68][69][70][71][72][73][74][75][76][77]78,79,80,81,82 . Randomized and quasi-randomized studies.…”

“…Thirty-five RCT and 2 quasi-RCT involving 4908 participants (range 14-611, mean 133), published between 1966 and 2006, were included. Twenty-four studies (65%) were published before 1990 38,39,40,44,45,46,51,52,53,54,55,56,57,58,60,61,62,63,64,65,67,68,73,74,77,78,79 . The mean age of participants (reported in 26/37 trials) was 40.5 years (SD 11.1) and 81% were men (reported in 36 studies).…”

“…Effects of interventions. Thirty-one trials (n = 4356 participants) contributed to the pooled analyses [traditional NSAID vs placebo (n = 5) 41,48,49,50,80 , COX-2 vs placebo (n = 3) 41,48,80 , COX-2 vs traditional NSAID (n = 4) 41,48,76,80 , NSAID vs NSAID (n = 24) 42,44,45,46,49,51,52,53,55,57,58,61,62,63,64,66,67,68,69,70,73,74,75,77,79,81 , naproxen vs other NSAID (n = 3) 41,70,80 , and low-vs high-dose NSAID (n = 5) 41,49,50,76,80 ]. Eight remaining studies could not be included in the metaanalysis because of study design (i.e., being cohort studies 43,71,72...…”