Author(s):
Machado, P. M. ; Cerqueira, M. ; Ávila-Ribeiro, P. ; Aguiar, R. ; Bernardo, A. ; Sepriano, Alexandre ; Águeda, A. ; Cordeiro, A. ; Raposo, A. ; Rodrigues, A. M. ; Barcelos, A. ; Malcata, A. ; Lopes, C. ; Vaz, C. C. ; Nour, D. ; Godinho, F. ; Alvarenga, F. ; M. Pimentel-Santos, F. ; Canhão, Helena ; Santos, H. ; Cunha, I. ; Neves, J. S. ; Fonseca, J. E. ; Gomes, J. L. ; Tavares-Costa, J. ; Costa, L. ; Cunha-Miranda, L. ; Maurício, L. ; Cruz, M. ; Afonso, M. C. ; Santos, M. J. ; Bernardes, M. ; Valente, P. ; Figueira, R. ; Pimenta, S. ; Ramiro, Sofia ; Pedrosa, T. ; Costa, T. A. ; Vieira-Sousa, E. ; Sociedade Portuguesa de Reumatologia (SPR)
Date: 2018
Origin: Repositório Institucional da UNL
Subject(s): Ankylo - sing spondylitis; Axial spondyloarthritis; Biological therapies; Guidelines; Portugal; Re - commendations; Rheumatology
Description
Objective: To update the recommendations for the treatment of axial spondyloarthritis (axSpA) with biological therapies, endorsed by the Portuguese Society of Rheumatology. Methods: These treatment recommendations were formulated by Portuguese rheumatologists based on lite - rature evidence and consensus opinion. At a national meeting, the 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. Results: A consensus was achieved regarding the initiation, assessment of response and switching of biological therapies in patients with axSpA. In total, se ven 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 ge - neral 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 di - sease (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 ina -dequate response (where switching is recommended) or in the presence of long-term remission (where a process of biological therapy optimization can be consi - dered, either a gradual increase in the interval between doses or a decrease of each dose of the biological the - rapy). Conclusion: These recommendations may be used for guidance in deciding which patients with axSpA should be treated with biological therapies. They co - ver 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.
