The effects of an orally administered probiotic on sulfasalazine metabolism in individuals with rheumatoid arthritis: a preliminary study

• Published in: International journal of rheumatic diseases Vol. 13; no. 1; pp. 48 - 54
• Main Authors: LEE, Hee Ji, WALLER, Rosmary D., STEBBINGS, Simon, HIGHTON, John, ORLOVICH, David A., SCHMIERER, David, FAWCETT, J. Paul
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.02.2010; Wiley Subscription Services, Inc
• Subjects: Administration, Oral; Adult; Aged; Animal models; Antirheumatic Agents - adverse effects; Antirheumatic Agents - blood; Antirheumatic Agents - metabolism; Antirheumatic Agents - therapeutic use; Antirheumatic Agents - urine; Arthritis, Rheumatoid - drug therapy; Arthritis, Rheumatoid - microbiology; Bifidobacterium - growth & development; Bifidobacterium - metabolism; Biotransformation; Blood; Drug Interactions; Feces; Feces - microbiology; Female; Gel electrophoresis; gut microbiota; Humans; Lactobacillus acidophilus - growth & development; Lactobacillus acidophilus - metabolism; Male; metabolism; Metabolites; Middle Aged; Oral administration; Pilot Projects; Plasma levels; probiotics; Probiotics - administration & dosage; Probiotics - adverse effects; Rheumatoid arthritis; Statistical analysis; Streptococcus - growth & development; Streptococcus - metabolism; Sulfapyridine; Sulfapyridine - blood; Sulfapyridine - urine; sulfasalazine; Sulfasalazine - adverse effects; Sulfasalazine - blood; Sulfasalazine - metabolism; Sulfasalazine - therapeutic use; Sulfasalazine - urine; Urine
• ISSN: 1756-1841; 1756-185X; 1756-185X
• DOI: 10.1111/j.1756-185X.2009.01449.x

Aim:  To carry out a pilot study to investigate the effect of short‐term oral probiotic administration on the metabolism of sulfasalazine (SSZ) in patients with rheumatoid arthritis (RA) stabilized on SSZ. Methods:  Twelve subjects with RA taking stable doses of SSZ for a minimum of 3 months prior to the study, received a probiotic preparation contained three strains of bacteria (1.8 × 109 CFU/day) twice daily for 1 week. Single point blood and 12‐h urine samples were taken before and after probiotic treatment and 3 weeks following discontinuation of probiotics, for determination of SSZ and its metabolites. The presence of the probiotic bacteria in the feces of patients was investigated by denaturing gradient gel electrophoresis (DGGE). Results:  Adverse events recorded were three instances of gastrointestinal disturbance and one flare of RA. Plasma and urinary levels of SSZ and its metabolites showed no statistically significant changes after probiotic administration and the incidence of gastrointestinal disturbance did not appear to be ascribed to higher sulfapyridine plasma levels. Probiotic‐specific DGGE bands were detected in the feces of some patients after the treatment period. Conclusions:  Short‐term treatment of RA patients with a multi‐strain probiotic did not significantly influence SSZ metabolism as has been demonstrated in animal models.