Machado Pedro, Cerqueira Marcos, Ávila-Ribeiro Pedro, Aguiar Renata, Bernardo Alexandra, Sepriano Alexandre, Águeda Ana, Cordeiro Ana, Raposo Ana, Rodrigues Ana M, Barcelos Anabela, Malcata Armando, Lopes Carina, Vaz Cláudia C, Nour Dolores, Godinho Fátima, Alvarenga Fernando, Pimentel-Santos Fernando, Canhão Helena, Santos Helena, Cunha Inês, Neves Joana Sousa, Fonseca João Eurico, Gomes João Lagoas, Tavares-Costa José, Costa Lúcia, Cunha-Miranda Luís, Maurício Luís, Cruz Margarida, Afonso Maria Carmo, Santos Maria José, Bernardes Miguel, Valente Paula, Figueira Ricardo, Pimenta Sofia, Ramiro Sofia, Pedrosa Teresa, Costa Tiago Afonso, Vieira-Sousa Elsa
University College London, London, UK.
Rheumatology Department, Unidade Local de Saúde do Alto Minho, Hospital Conde de Bertiandos, Ponte de Lima, Portugal.
Acta Reumatol Port. 2017 Jul-Sep;42(3):209-218.
To update the recommendations for the treatment of axial spondyloarthritis (axSpA) with biological therapies, endorsed by the Portuguese Society of Rheumatology.
These treatment recommendations were formulated by Portuguese rheumatologists based on literature evidence and consensus opinion. At a national meeting, the 7 recommendations included in this document were discussed and updated. A draft of the full text of the recommendations was then circulated and suggestions were incorporated. A final version was again circulated before publication and the level of agreement among Portuguese Rheumatologists was anonymously assessed using an online survey.
A consensus was achieved regarding the initiation, assessment of response and switching of biological therapies in patients with axSpA. In total, seven recommendations were produced. The first recommendation is a general statement indicating that biological therapy is not a first-line drug treatment option and should only be used after conventional treatment has failed. The second recommendation is also a general statement about the broad concept of axSpA adopted by these recommendations that includes both non-radiographic and radiographic axSpA. Recommendations 3 to 7 deal with the definition of active disease (including the recommended threshold of 2.1 for the Ankylosing Spondylitis Disease Activity Score [ASDAS] or the threshold of 4 [0-10 scale] for the Bath Ankylosing Spondylitis Disease Activity Index [BASDAI]), conventional treatment failure (nonsteroidal anti-inflammatory drugs being the first-line drug treatment), assessment of response to treatment (based on an ASDAS improvement of at least 1.1 units or a BASDAI improvement of at least 2 units [0-10 scale] or at least 50%), and strategy in the presence of an inadequate response (where switching is recommended) or in the presence of long-term remission (where a process of biological therapy optimization can be considered, either a gradual increase in the interval between doses or a decrease of each dose of the biological therapy).
These recommendations may be used for guidance in deciding which patients with axSpA should be treated with biological therapies. They cover a rapidly evolving area of therapeutic intervention. As more evidence becomes available and more biological therapies are licensed, these recommendations will have to be updated.
