Side Effects of sulfasalazine: A Synthesis of Findings from 24 Studies

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Original Abstract of the Article

Main Research Findings

Sulfasalazine is a medication used to treat autoimmune diseases such as rheumatoid arthritis, inflammatory bowel disease, and ankylosing spondylitis. Multiple studies have shown that sulfasalazine is effective for these diseases. However, sulfasalazine can cause some side effects, and its safety needs to be considered.

The therapeutic effect of sulfasalazine varies from patient to patient, and in a study of 22 , a good or moderate effect was found in 58.7% of patients. Side effects occurred in 40.5% of the treated patients, mostly in the first 4 months after starting treatment, but some of the more serious adverse reactions occurred some months later.

Reasons for Side Effects

Sulfasalazine is metabolized by gut bacteria into 5-aminosalicylic acid (5-ASA). 5-ASA is thought to be effective in treating diseases such as inflammatory bowel disease. However, sulfasalazine also produces other metabolites, such as sulfapyridine, in addition to 5-ASA. These metabolites can affect various organs such as the liver, kidneys, and blood, potentially causing side effects.

Common Side Effects

Gastrointestinal

Sulfasalazine is known to cause the most side effects in the gastrointestinal system. These side effects include nausea, vomiting, abdominal pain, diarrhea, and constipation. These side effects often occur within a few weeks after starting sulfasalazine treatment and are mostly mild. They usually improve with continued treatment. In a study by 22 , it was reported that these side effects occurred most frequently within 4 months after the start of treatment.

Hematological

Sulfasalazine can also cause side effects in the blood system. These side effects include anemia, leukopenia, and thrombocytopenia. These side effects may occur weeks to months after starting sulfasalazine treatment. In severe cases, treatment such as blood transfusion or bone marrow transplantation may be necessary. Studies by , 18 , and 1 have reported hematological side effects such as anemia and leukopenia caused by sulfasalazine.

Liver

Sulfasalazine can cause side effects in the liver. These side effects include liver dysfunction and hepatitis. These side effects may occur weeks to months after starting sulfasalazine treatment. In severe cases, treatment such as liver transplantation may be necessary. Studies by 8 and 22 have reported liver side effects such as liver dysfunction caused by sulfasalazine.

Kidney

Sulfasalazine can cause side effects in the kidneys. These side effects include kidney dysfunction and kidney stones. These side effects may occur weeks to months after starting sulfasalazine treatment. In severe cases, treatment such as dialysis may be necessary. A study by 24 reported kidney stones caused by sulfasalazine.

Other

Sulfasalazine can cause various other side effects besides those mentioned above. These side effects include rash, itching, headache, dizziness, shortness of breath, and swelling. These side effects may occur weeks to months after starting sulfasalazine treatment. In severe cases, it may be necessary to discontinue treatment. Various studies have reported side effects such as rash and headache caused by sulfasalazine.

Side Effect Countermeasures

Gastrointestinal

To reduce gastrointestinal side effects from sulfasalazine, measures such as diet therapy and drug therapy are taken. Dietary therapy includes eating easily digestible foods, eating small meals several times a day, and drinking plenty of fluids. Drug therapy includes the use of antiemetics, analgesics, and antidiarrheals.

Hematological

To prevent hematological side effects from sulfasalazine, it is important to have regular blood tests to check the number of white blood cells, red blood cells, and platelets in the blood. If symptoms such as fever, fatigue, or bleeding occur, consult a doctor immediately.

Liver

To prevent liver side effects from sulfasalazine, it is important to have regular liver function tests to check liver function. If symptoms such as jaundice, abdominal pain, or loss of appetite occur, consult a doctor immediately.

Kidney

To prevent kidney side effects from sulfasalazine, it is important to have regular kidney function tests to check kidney function. If symptoms such as swelling, changes in urine volume, or blood in the urine occur, consult a doctor immediately.

Other

To prevent other side effects from sulfasalazine, if symptoms such as rash, itching, headache, dizziness, shortness of breath, or swelling occur, consult a doctor immediately. When using sulfasalazine, it is important to take it according to your doctor's instructions. Do not stop taking it or change the dosage without consulting your doctor.

Comparison Between Studies

Commonalities

Multiple studies have shown that sulfasalazine is effective for treating autoimmune diseases such as rheumatoid arthritis, inflammatory bowel disease, and ankylosing spondylitis. Studies by 22 , 2 , and 13 have shown the effectiveness of sulfasalazine. Many studies have also reported that sulfasalazine can cause a variety of side effects, including the gastrointestinal system, blood system, liver, and kidneys.

Differences

The effectiveness and frequency and severity of side effects of sulfasalazine vary from study to study. This is because there are many factors that can affect these outcomes, such as the type and severity of the disease, the age, sex, and concomitant medications of the study participants. In addition, the study methods and evaluation indicators differ, making it difficult to simply compare the results of the studies.

Precautions for Application in Real Life

Sulfasalazine is an effective drug for treating autoimmune diseases, but it can cause various side effects. When using sulfasalazine, it is important to take it according to your doctor's instructions and not stop taking it or change the dosage without consulting your doctor. If you experience any changes in your health while taking it, consult your doctor immediately.

Limitations of Current Research

Research on sulfasalazine is still not sufficient. In particular, there has not been enough research on the effects of long-term use of sulfasalazine. Further research is needed to better understand the effectiveness and side effects of sulfasalazine.

Future Research Directions

Further research is needed on the effectiveness and safety of sulfasalazine. In particular, research is needed on the effects of long-term use of sulfasalazine, the interactions of sulfasalazine with other drugs, and ways to reduce side effects caused by sulfasalazine.

Conclusion

Sulfasalazine is an effective drug for treating autoimmune diseases such as rheumatoid arthritis, inflammatory bowel disease, and ankylosing spondylitis, but it can cause some side effects. When using sulfasalazine, it is important to take it according to your doctor's instructions and not stop taking it or change the dosage without consulting your doctor. If you experience any changes in your health while taking it, consult your doctor immediately. Further research on sulfasalazine is expected to enable it to be used more safely and effectively as a drug.

Literature analysis of 24 papers
Positive Content
18
Neutral Content
1
Negative Content
5
Article Type
0
1
3
8
21
1.

Mesalazine as a cause of fetal anemia and hydrops fetalis: A case report.

Author: EkSverker, RosenborgStaffan

Fetal anemia
Hydrops

Sulfasalazine, used for inflammatory bowel disease, is associated with hematological side effects. This case report describes a fetus with severe anemia and hydrops, potentially caused by sulfasalazine exposure.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

2.

Sulfasalazine for ankylosing spondylitis.

Author: ChenJunmin, LinShaopeng, LiuChao

AS treatment

Ankylosing spondylitis (AS) is a chronic inflammatory condition that primarily affects the spine and can limit movement. Sulfasalazine is a medication used to treat AS, but its effectiveness is uncertain. This review updates previous research on the use of sulfasalazine for AS.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

3.

A case of refractory intestinal Behçet's disease treated with tocilizumab, a humanised anti-interleukin-6 receptor antibody.

Author: ChenJiali, ChenShi, HeJing

Behçet's disease treatment
Tocilizumab effective
Side effects

This case study describes a patient with refractory intestinal Behçet's disease who experienced symptom resolution after receiving tocilizumab, a humanized anti-interleukin-6 receptor antibody. This suggests that tocilizumab may be an effective treatment option for intestinal Behçet's disease that is resistant to conventional therapies.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

4.

Breast cancer resistance protein (ABCG2) in clinical pharmacokinetics and drug interactions: practical recommendations for clinical victim and perpetrator drug-drug interaction study design.

Author: LeeCaroline A, O'ConnorMeeghan A, RitchieTasha K, GaletinAleksandra, CookJack A, Ragueneau-MajlessiIsabelle, EllensHarma, FengBo, TaubMitchell E, PaineMary F, PolliJoseph W, WareJoseph A, Zamek-GliszczynskiMaciej J

Drug efficacy and safety
Drug-drug interactions

This review discusses the challenges and proposes strategies for conducting clinical drug-drug interaction (DDI) studies that are mediated by breast cancer resistance protein (BCRP). BCRP is a transporter protein involved in drug absorption and excretion. The review recommends specific substrates (sulfasalazine, rosuvastatin) and inhibitors (curcumin, lapatinib) for clinical DDI studies and suggests study design considerations to assess the worst-case scenario.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

5.

Low Persistence Rates in Patients With Rheumatoid Arthritis Treated With Triple Therapy and Adverse Drug Events Associated With Sulfasalazine.

Author: ErhardtDaniel P, CannonGrant W, TengChia-Chen, MikulsTed R, CurtisJeffrey R, SauerBrian C

Treats rheumatoid arthritis

This study examined persistence and adherence rates of two combination therapies for rheumatoid arthritis (RA) in US veterans. The therapies involved adding a tumor necrosis factor inhibitor (TNFi) or adding sulfasalazine (SSZ) and hydroxychloroquine to methotrexate (MTX) (triple therapy). The study also reported reasons for discontinuation of treatment in each group.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Observational StudyResearch that observes and collects data on participants' behavior and outcomes in their natural state, without intervention.
Research Support, N.I.H., ExtramuralResearch funding provided by the NIH to external research institutions and researchers.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
Research Support, U.S. Gov't, Non-P.H.S.Research funding provided by US government agencies other than the Public Health Service.

Language : English

6.

Mesalazine-induced lung fibrosis.

Author: AlskafEbraheem, AljoudehAmer, EdenboroughFrank

Effective for Crohn's
Lung fibrosis

This case report describes a Crohn's patient who developed lung fibrosis associated with mesalazine treatment.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

7.

Sulfasalazine in dermatology: A lesser explored drug with broad therapeutic potential.

Author: MushtaqSabha, SarkarRashmi

dermatological treatment
limited evidence
side effects

Sulfasalazine, an aminosalicylate primarily used for rheumatoid arthritis and ulcerative colitis, is often used off-label in dermatology. This review discusses its pharmacology, modes of action, side effects, and contraindications, highlighting the need for further research to establish its efficacy and safety in dermatological conditions.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

9.

Adverse reaction profile of sulfasalazine and its persistence in chronic therapy of rheumatoid arthritis and spondyloarthritis: A multicentric observational study.

Author: JayachandranMamatha, KoshyVarghese, DavidRosme, SanthakumariVanditha, PadmanabhanDakshin Sitaram, SurendranSandeep, TiwariArun, MithunC B, SinghSantosh Kumar, SumanSaroj Kumar, YadavPriyank, SinghalAnuj, NairAnjana S, MarwahaVishal, PalattyPrincy Louis

Safe rheumatoid arthritis treatment
Safe spondyloarthritis treatment
Deranged liver enzymes
Gastritis
Hepatitis
Skin rashes

Sulfasalazine is a safe option in chronic therapy of rheumatoid arthritis and spondyloarthritis, but adverse drug reactions (ADRs) can occur, requiring discontinuation in 10.1% of patients. ADRs were most commonly encountered within the first year of using the drug.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Observational StudyResearch that observes and collects data on participants' behavior and outcomes in their natural state, without intervention.

Language : English

11.

A Case Report of Intratesticular Hematoma in a Patient with Reiter's Syndrome.

Author: JhangJia-Jyun, ChenSzu-Ju, HuangChi-Ping, ChenHuey-Yi, LinWei-Ching, ChenYung-Hsiang, ChenWen-Chi

Fertility changes
Sulfasalazine side effect
Testicular hematoma

A case report of a 28-year-old male patient with a spontaneous intratesticular hematoma is presented. Sulfasalazine, a drug used to treat Reiter's syndrome, may be a rare cause of this condition.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.

Language : English

12.

Acute eosinophilic pneumonia related to a mesalazine suppository.

Author: KimJung Hyun, LeeJune-Hyuk, KohEun-Suk, ParkSung Woo, JangAn-Soo, KimDojin, ParkChoon-Sik

Lung disease

This case report describes a 30-year-old woman who developed interstitial lung disease after using mesalazine suppositories for ulcerative colitis. The patient's lung biopsy showed eosinophilic pneumonia combined with bronchiolitis obliterans with organizing pneumonia (BOOP). The case highlights the potential for mesalazine, even in topical formulations, to cause lung toxicity.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.

Language : English

13.

Safety of long-term use of four common conventional disease modifying anti-rheumatic drugs in rheumatoid arthritis.

Author: KediaArun Kumar, MohansundaramKavitha, GoyalMohit, RavindranVinod

Treats rheumatoid arthritis
Safety concerns

Conventional disease-modifying antirheumatic drugs (DMARDs) like methotrexate, leflunomide, hydroxychloroquine, and sulfasalazine are widely used for treating rheumatoid arthritis. This narrative review critically appraises the available literature on the long-term safety of these DMARDs, highlighting the importance of weighing their benefits against potential risks.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

16.

The impact of drugs on male fertility: a review.

Author: SemetM, PaciM, Saïas-MagnanJ, Metzler-GuillemainC, BoissierR, LejeuneH, PerrinJ

Reversible effects
Sexual dysfunction
Spermatogenesis impairment

This systematic review summarizes existing data on the negative impact of pharmacological treatments (excluding cytotoxic drugs) on male fertility. The review highlights the various mechanisms by which drugs can affect male fertility, including hormonal and non-hormonal effects. It emphasizes the importance of considering drug-induced fertility impacts and the role of sperm cryopreservation in certain cases.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

18.

Sulfasalazine-induced Pancytopenia Indicating Bone Marrow Suppression: A Rare Pediatric Case Report from Pakistan.

Author: MarsiaShayan, MahmoodSamar, RazaMohammad, NusratKhushboo, SaleemAyesha

JIA treatment
Sulfasalazine efficacy
Bone marrow suppression

Sulfasalazine, a disease-modifying antirheumatic drug (DMARD) used in juvenile idiopathic arthritis (JIA), can cause bone marrow suppression, a rare side effect in children.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.

Language : English

19.

Successful treatment of SAPHO syndrome with apremilast.

Author: AdamoS, NilssonJ, KrebsA, SteinerU, CozzioA, FrenchL E, KoliosA G A

SAPHO treatment
Hypersensitivity
Infections

A 24-year-old woman with SAPHO syndrome was treated with several medications including TNF inhibitors, ustekinumab, and secukinumab before finally finding relief with apremilast, a pan-cytokine approach. This is the first case report of apremilast being used to treat SAPHO syndrome.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

20.

New strategies for patenting biological medicines used in rheumatoid arthritis treatment.

Author: OliveiraRodrigo Ayres de, FierroIolanda M

Clinical remission of RA
New antirheumatic drugs
RA drug costs
Side effects of RA drugs

Rheumatoid arthritis (RA) is a chronic autoimmune disease with a global prevalence of 0.3% to 1%. Current RA treatment strategies involve aggressive and stepped therapies, but new drugs are needed to overcome limitations of existing treatments.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

21.

Use of nonbiologic treatments in antihistamine-refractory chronic urticaria: a review of published evidence.

Author: HolmJesper Grønlund, IvyanskiyIlya, ThomsenSimon Francis

Chronic urticaria treatment
Side effects

This review article discusses the effectiveness and safety of nonbiologic and nonantihistamine treatments for chronic urticaria, focusing on options for patients who do not respond well to omalizumab.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

22.

[Therapy study of chronic polyarthritis with sulfasalazine with special emphasis on the profile of side effects].

Author: LonauerG

Effective for rheumatoid arthritis
Antinuclear antibodies
Side effects

Sulfasalazine was effective in treating rheumatoid arthritis in 58.7% of patients, but side effects occurred in 40.5% of patients, mostly within the first four months of treatment.

English AbstractA summary of a research paper/publication written in English for a wider audience.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : German

24.

Sulfasalazine-Induced Crystalluria Causing Severe Acute Kidney Injury.

Author: DurandoMichael, TiuHannah, KimJames Soo

Nephrolithiasis

This study reports a case of severe acute kidney injury and nephrolithiasis in a patient with Crohn's disease who was treated with sulfasalazine for over 10 years. The case highlights the potential for renal complications, specifically nephrolithiasis, with sulfasalazine therapy and emphasizes the importance of hydration in patients on sulfasalazine.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

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