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To achieve induction and maintenance of remission in ankylosing spondylitis (AS) refractory to nonsteroidal antiinflammatory drugs with "step-down bridge combination" of 5 immunosuppressants, as an alternative to costly biologic DMARD. Primary endpoints were the percentage of patients achieving ASAS 20 at the end of Year 6; secondary endpoints were patients achieving ASAS 50 and ASAS 70, induction and maintenance of clinical and radiological remission, and the side effects of this combination of immunosuppressive drugs. In a 6-year uncontrolled international open-label prospective study, 54 men and 25 women with AS were enrolled after exclusion criteria were applied. Included patients were treated with individualized combinations of low-dose intravenous methylprednisolone + cyclophosphamide + methotrexate (for the first 6 mo). When erythrocyte sedimentation rate …