Ankylosing Spondylitis AS. NSAIDs. NSAIDs 100% B27 NSAID ~ 90% FDA EMA

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1 Ankylosing Spondylitis AS human leukocyte antigen HLA- AS NSAIDs NSAIDs B27 100% NSAIDs NSAIDs 90% NSAID ~ AS 0.25% 2~ % 1 AS CFDA FDA EMA 14 AS NSAIDs 2 CFDA non-ster- AS 1 oidal anti-inflammatory drugs NSAIDs NSAIDs tumor necrosis factor TNF-α TNF-α AS AS Thomson Class Ⅰ Class Ⅱa Category B FDA TNF - AS Thomson Class Ⅱa Class Ⅱb Category A 3 1 AS China Food and Thomson Healthcare MICROMEDEX Drug Administration CFDA AS AS 1 AS AS CFDA AS 1 2 AS 2.1 NSAIDs NSAIDs 2 2 ~ AS 4 NSAIDs 2015 American College CFDA FDA EMA AS 2010 AS 2 1 NSAID 2 NSAIDs NSAID NSAIDs of Rheumatology ACR Spondylitis Association of America SAA Spondyloarthritis Research and Treatment 2 Network SPARTAN AS Pharmacy Today 2017 January Vol.27 No.1 1

2 1 AS AS AS 1. TNF-α TNF - 2. * 3. * ** ** -A ** 4. NSAIDs * AS ** 2 Pharmacy Today 2017 January Vol.27 No

3 2 NSAIDs CFDA FDA EMA AS CFDA FDA EMA Thomson Healthcare MICROMEDEX Class I Class IIb Category B Class I Class I Category B - Class I Class I Category A Class I Class IIa Category B AS AS AS - Class I Class I Category A - AS - Class I Class IIa Category B Class IIa Class IIb Category A AS - AS - AS - AS CFDA FDA EMA AS AS CFDA 2015 ACR SAA SPARTAN AS 1 AS methotrexate MTX NSAIDs AS TNF-α TNF-α TNF-α TNF-α 80% RNA TNF-α AS ~ 90% ASAS /EULAR AS TNF-α AS TNF-α 100% NSAIDs ASAS /EULAR AS TNF-α AS TNF-α AS ~ 100% AS C 2 AS 1 Thomson Healthcare MICROMEDEX Thomson Class Ⅱa Class Ⅱb C TNF-α TNF-α Pharmacy Today 2017 January Vol.27 No.1 3

4 3 AS * ** Thomson 60 mg / 120 mg / 60~ 120 mg /d FDA AS Thomson Class IIa Class IIb Category A 0.1 g / 0.2 g / 0.2 g / 1 FDA / AS Thomson Class I Class IIa Category B 25 mg / 25 ~ 50 FDA mg /d AS Thomson Class Ⅱa Class 50 ~ 100 mg /d Ⅱb Category C 2. 5mg / MICROMEDEX / 5mg / 5 mg /1 ml 10 mg / AS 1 ml 7. 5 ~ 10 mg / 5 mg / FDA AS MICROMEDEX AS 5 mg / FDA AS Thomson Class I Class IIa Category B 300 mg / 2~ ~ 600 mg MICROMEDEX 20 mg / 30 ~ 60 mg /d3 MICROMEDEX 20 mg / 3 20~ 60 mg MICROMEDEX * CFDA FDA AS Thomson Healthcare MICROMEDEX AS ** Thomson Healthcare MICROMEDEX AS 150 mg /d 25~50mg /d 30 ASAS20 AS 50 ~ 100 mg /d Pharmacy Today 2017 January Vol.27 No

5 2g /d n = 33 NSAIDs n = 37 2 MTX 10 mg ACR SAA SPARTAN AS AS 100% MTX 2006 ASAS /EULAR AS MTX AS AS MTX AS FDA TNF-α AS AS 3 MTX NSAIDs 2010 ASAS /EULAR AS AS MTX AS MTX 100% ACR SAA SPARTAN AS 3 1 MTX AS 2001 NSAIDs AS 51 AS 1000 mg /d MTX 7.5 mg 100% AS MTX 7.5 mg NSAIDs AS 1 MTX 15 mg4 MTX 20 mg12 25% ASAS20 10% ASAS40 ASAS70 9 MTX 10 AS Thomson Healthcare MICROMEDEX MTX AS TNF-α 1 ~ 2 1 AS TNF-α CFDA -A NSAIDs AS AS TNF-α AS MTX 2 1 MTX NSAIDs AS 100% NSAIDs Pharmacy Today 2017 January Vol.27 No.1 5

6 AS 2010 AS TNF-α NSAIDs AS AS 2 MTX Meta ~ AS 13 CFDA Thomson Healthcare MICROMEDEX 2 ~ ~ 600 mg 2 30 ~ 60 mg /d 3 3 Thomson ~ 60 mg 3 NSAIDs TNF-α AS 5 4 CFDA AS A B C 4 NSAIDs TNF-α AS Class I ClassII a Effective Evidence Favors Efficacy ClassII b Evidence is Inconclusive ClassIII Ineffective 5 Class I Recommended ClassII a Recommended In Most ClassII b ClassIII Class Indeterminate Recommended In Some Not Recommended 6 Category A Category B Category C No Evidence 6 Pharmacy Today 2017 January Vol.27 No

7 1 Ward MM Deodhar A Akl EA et al. American College of Rheumatology / Spondylitis Association of America / Spondyloarthritis Research and Treatment Network 2015 recommendations for the treatment of ankylosing spondylitis and nonradiographic axial spondyloarthritis J. Arthritis Rheumatol J Firestein GS Budd RC Gabriel SE et al. Kelley' s Textbook of Rheumatology 9th edition Zochling J van der Heijde D Burgos-Vargas R et al. ASAS /EU- LAR recommendations for the management of ankylosing spondylitis J. Ann Rheum Dis Braun J van den Berg R Baraliakos X et al update of the ASAS / EULAR recommendations for the management of ankylosing spondylitis J. Ann Rheum Dis Deng X Zhang J Zhang J et al. Thalidomide reduces recurrence of ankylosing spondylitis in patients following discontinuation of etanercept J. Rheumatol Int Altan L Bing l U Karako Y et al. Clinical investigation of methotrexate in the treatment of ankylosing spondylitis J. Scand J Rheumatol Gonzalez-Lopez L1 Garcia-Gonzalez A Vazquez-Del-Mercado M et al. Efficacy of methotrexate in ankylosing spondylitis a randomized double blind placebo controlled trial J. J Rheumatol Haibel H Brandt HC Song IH et al. No efficacy of subcutaneous methotrexate in active ankylosing spondylitis a 16-week open-label. trial J. Ann Rheum Dis van den Berg R Baraliakos X Braun J et al. First update of the current evidence for the management of ankylosing spondylitis with non-pharmacological treatment and non-biologic drugs a systematic literature review for the ASAS / EULAR management recommendations in ankylosing spondylitis J. Rheumatology Oxford Meta J Li H Guo F Luo YC et al. Efficacy of tripterygium glycosides tablet in treating ankylosing spondylitis a systematic review and meta-analysis of randomized controlled trials J. Clin Rheumatol J wqw_sw@ 163.com liedai2004@ 163.com junewu@ tom.com Pharmacy Today 2017 January Vol.27 No.1 7

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