***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Seminal abnormalities are a common side effect of salazosulphapyridine ( SASP ) treatment . We evaluated semen qualities and sex hormone concentrations in 11 patients with inflammatory bowel disease ( IBD ) during SASP treatment and 4 months after replacing SASP with an oral slow-release preparation of 5-aminosalicylic acid ( 5-ASA ) .  Significant improvement in sperm count ( p less than 0.01 ) , morphology ( p less than 0.02 ) , and motility ( p less than 0.02 ) could be observed during 5-ASA therapy , in comparison with SASP treatment . Three pregnancies occurred during the study period . The serum concentrations of gonadotrophins , prolactin , and sex hormone-binding globulin were normal in all patients and not significantly different in the two treatment periods . The mean total testosterone concentration decreased significantly ( p less than 0.02 ) after 5-ASA substitution , together with serum albumin ( p less than 0.005 ) , although all values remained within normal limits . The apparent free testosterone concentration was not significantly different in the two treatment periods . It is concluded that a significant improvement in semen quality can be obtained in male patients with IBD after replacing SASP with 5-ASA Sulphasalazine ( SASP ) is now accepted as an effective slow-acting antirheumatic drug for treating active rheumatoid arthritis ( RA ) , but has not been previously evaluated in psoriatic arthritis . An earlier open study suggested that it was well tolerated and potentially beneficial . The present double-blind placebo-controlled trial of 30 patients has now confirmed its efficacy . Greater improvement occurred in those patients on active treatment than on placebo , with more benefit being detected in those patients with the symmetrical polyarticular but seronegative pattern of arthritis associated with a high acute-phase response .  SASP was stopped in 26 % because of side-effects but these were mild . No exacerbation or remission of psoriasis was observed . Further studies are in progress to determine the degree of efficacy of SASP in different clinical subgroups of psoriatic arthritis Sulphasalazine ( SASP ) and methotrexate ( MTX ) are well-established treatments for RA but the use of these drugs in combination has been avoided as both have antifolate activity . In this paper we report our experience with 32 patients treated with the combination MTX/SASP and compare the toxicity and tolerability of the combination with 63 patients treated with MTX alone .  The median duration of exposure to the combination was 23 months . Nineteen patients have continued this regime for over 18 months . Five patients on MTX/SASP combination discontinued MTX , in four cases due to toxicity and in one because MTX/SASP was ineffective . In 17 patients on MTX alone  , the drug was withdrawn permanently . In seven cases the cause was toxicity including two patients with severe reactions . In patients known to tolerate SASP alone , the combination of MTX/SASP is also well tolerated . In our experience of 48 patient-years of such combination therapy , there is no increase in toxicity compared to therapy with MTX alone in RA Desensitization to sulfasalazine was successful in 40/47 ( 85 % ) patients with IBD who previously had hypersensitivity reactions . The desensitization with sulfasalazine was well-tolerated with no serious complications in short- or long-term follow-up . The course of IBD was subsequently favorable in 35/40 ( 87 % ) for extended periods including 17/17 ( 100 % ) with ulcerative colitis . Desensitization should be attempted in patients who have had typical hypersensitivity reactions to sulfasalazine OBJECTIVE Case reports have suggested that minocycline , sulfasalazine , and penicillamine are associated with antineutrophil cytoplasmic antibody (ANCA)-positive vasculitis . This study evaluated ANCA seroconversion due to these agents in serum sample s prospect ively collected in r and omized , double-blind , controlled trials . METHODS The sources of study sera were 3 clinical trials : 1 ) a 48-week trial of  minocycline for early rheumatoid arthritis , with 64 patients receiving minocycline compared with 68 receiving placebo ;  2 ) a 37-week trial of sulfasalazine for rheumatoid arthritis , with 51 receiving sulfasalazine compared with 38 receiving placebo ; and 3 ) a 104-week trial of penicillamine for early systemic sclerosis , with 15 undergoing high-dose penicillamine treatment versus 12 receiving low-dose penicillamine . ANCA were measured in the baseline and study -end serum sample s by indirect immunofluorescence ( IIF ) for perinuclear ANCA ( pANCA ) and cytoplasmic ANCA ( cANCA ) patterns , and by antigen-specific enzyme-linked immunosorbent assay ( ELISA ) for antibodies to myeloperoxidase ( anti-MPO ) and proteinase 3 ( anti-PR3 ) . Laboratory personnel were blinded to the group identity of the sample s. ANCA results were interpreted using an ANCA scoring system that combines the results of IIF and ELISA testing . RESULTS No patient in any of the active study drug groups demonstrated ANCA seroconversion according to the final interpretation of the combined IIF and ELISA results . Twelve of the 248 patients ( 5 % ) were positive for anti-MPO with pANCA at baseline . No subject was positive for anti-PR3 with cANCA . There were no findings suggestive of vasculitis in any of these patients . CONCLUSION From our study results , there was no suggestion of ANCA seroconversion induced by minocycline , sulfasalazine , or penicillamine . However , these findings do not rule out the possibility of rare , sporadic cases of either ANCA seroconversion or true drug-induced vasculitis with these drugs Background The prognosis of patients suffering from WHO grade 3 and 4 astrocytic glioma remains poor despite surgery , radiation therapy and the use of current chemotherapy regimen . Indeed , the median survival of glioblastoma multiforme ( WHO grade 4 ) patients is at best 14.6 month with only 26.5 percents of the patients still alive after 2 years and the median survival of anaplastic astrocytomas ( WHO grade 3 ) is 19.2 month . Recent evidence suggests that the transcription factor NF-kappaB is constitutively expressed in malignant gliomas and that its inhibition by drugs like Sulfasalazine may block the growth of astrocytic tumors in vitro and in experimental models of malignant gliomas . Design ULg_GBM_04/1 is a prospect i ve , r and omized , double blind single-center phase 1–2 study . A total of twenty patients with progressive malignant glioma despite surgery , radiation therapy and a first line of chemotherapy  will be recruited and assigned to four dosage regimen of Sulfasalazine . This medication will be taken orally t.i.d . at a daily dose of 1.5–3–4 or 6 g , continuously until complete remission , evidence of progression or drug intolerance . Primary endpoints are drug safety in the setting of malignant gliomas and tumor response as measured according to MacDonald 's criteria . An interim analysis of drug safety will be conducted after the inclusion of ten patients . The complete evaluation of primary endpoints will be conducted two years after the enrolment of the last patient or after the death of the last patient should this occur prematurely . Discussion The aim of this study is to evaluate the safety and efficacy of Sulfasalazine as a treatment for recurring malignant gliomas . The safety and efficacy of this drug are analyzed as primary endpoints . Overall survival and progression-free survival are secondary endpoint Sulfasalazine is accepted therapy for active ulcerative colitis , but side‐effects and intolerance are common . Balsalazide is an azo‐bonded pro‐drug which also releases 5‐aminosalicylic acid into the colon , but uses an inert carrier molecule In a double blind , single observer , 48 week study the effects of sulphasalazine ( 2 g daily ) and hydroxychloroquine ( 400 mg daily months 0 - 6 , thereafter 200 mg daily ) were compared in 60 patients with definite or classical rheumatoid arthritis . They had not been treated previously with second line drugs . The onset of response with sulphasalazine was earlier than with hydroxychloroquine . After 48 weeks a comparison of the treatments showed no statistically significant differences in disease activity variables . Adverse reaction was the main reason for withdrawal in the sulphasalazine group and lack of efficacy in the hydroxychloroquine group . All adverse reactions , one being agranulocytosis after eight weeks of sulphasalazine treatment , appeared in the first three months of treatment and were completely reversible OBJECTIVES To study the outcome in clinical practice of first DMARD and /or corticosteroid ( CS ) treatment in patients with recent onset rheumatoid arthritis ( RA ) . PATIENTS 245 patients with active RA , not previously treated with DMARDs or CS  , were r and omised to one of two treatment groups , T1 = 7.5 - 15 mg of prednisolone ( PRE ) daily for one to three months followed , if needed , by methotrexate ( MTX ) in a weekly dose of 5 - 15 mg in addition to the lowest possible dose of PRE or T2 = sulfasalazine ( SAL ) , supplemented with lowest possible CS dose if needed . METHODS The EULAR individual response criteria were applied and remission was defined as a final DAS28 < 2.6 . Function was assessed by the HAQ and radiographic progression by Larsen scores . A patient who managed to remain on the allocated treatment for two years was described as a " completer " . RESULTS After 2 years of treatment , 70 % of the patients in T1 and 63 % in T2 were responders ( 30 % and 33 % " good responders " , respectively ) . In T1 29 % and in T2 19 % were in remission . There was a significant functional improvement in both groups but radiographic progression occurred . The mean decrease in HAQ and increase in the Larsen score were similar in the two groups . One-third of the patients were non-completers , 19 % from T1 and 47 % from T2 . Non-completers had , compared with completers , a significantly lower rate of individual response and remission . Completers and non-completers had similar functional improvement and similar radiological progression . CONCLUSIONS Individual response and remission was reduced in patients who did not complete their first DMARD/CS  treatment option . Treatment failures were significantly more frequent in the sulfasalazine plus optional CS than in the CS plus optional methotrexate treatment group Sulfasalazine is well established in the treatment of  active ulcerative colitis . Intolerance to sulfasalazine , however , is a common problem . Balsalazide has been design ed to deliver 5‐aminosalicylic acid to the colon without the poor tolerability of sulfasalazine OBJECTIVE To evaluate two monotherapies followed by step-up combination therapy with two or three complementary drugs in active rheumatoid arthritis ( RA ) in comparison with sulphasalazine ( SSZ ) alone . METHODS One hundred and twenty-six consecutive patients with early active RA were enrolled in this open controlled clinical trial . The primary end-point was 50 % improvement according to the ACR criteria ( ACR50 ) at 6 , 12 or 18 months . The secondary end-points were a full response ( Magnusson criteria ) and /or remission ( ACR criteria ) at 3 yr . Methotrexate ( MTX ) ( group 1 ) , cyclosporin A ( CsA ) ( group 2 ) or SSZ ( group 3 ) was used first . After 6 months , a combination of two drugs ( CsA and MTX ) was employed in groups 1 and 2 . SSZ was added after 12 months if improvement was less than ACR50 with the combination . Group 3 continued with SSZ alone . RESULTS After 6 months , 57 % of patients in group 1 , 31 % of group 2 ( MTX vs CsA , P=0.002 ) and 33 % of group 3 ( MTX vs SSZ , P=0.01 ) had reached ACR50 improvement according to intention-to-treat analysis . At month 12 after starting a drug combination , 67 % of group 1 and 76 % of group 2 had reached ACR50 compared with 24 % of group 3 . At the 18-month follow-up , 90 % of group 1 and 88 % of group 2 but only 24 % of group 3 had reached ACR50 . After 18 months , 62 % of group 1 , 60 % of group 2 and 48 % of group 3 showed side-effects and three , five and eight patients in the three groups respectively had dropped out of the study . At the 3-yr follow-up , 9 % of the patients in groups 1 and 2 and 7 % of group 3 were in remission according to the ACR criteria ; according to the Magnusson criteria , 40 % showed a full response in groups 1 and 2 but only 21 % did so in group 3 . CONCLUSION MTX appears to be the fastest-acting agent . A step-up approach with MTX plus CsA plus SSZ led to a 50 % improvement according to the ACR criteria in most patients . After 3 yr , 40 % of patients receiving combination therapy and 21 % of patients receiving monotherapy showed a full response , while 9 and 7 % respectively attained remission BACKGROUND Current disease management in rheumatoid arthritis ( RA ) has moved 
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CONCLUSIONS The adverse effects of SSZ vary with the pattern of acetylation .
Thus , in slow-acetylators , depending on the dosage of SSZ , the side effects increase significantly .
In the Spanish population slow-acetylators prevalence is higher than in other ethnic groups .
Therefore , one could infer that the incidence of adverse side effects by SSZ could be higher in the Spanish population than in others different ethnic groups .
We found no evidence that the Spanish population was more likely to suffer adverse effects by SSZ than other ethnic groups