TY - JOUR
T1 - 2019 Update of the American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis
AU - Ward, Michael M.
AU - Deodhar, Atul
AU - Gensler, Lianne S.
AU - Dubreuil, Maureen
AU - Yu, David
AU - Khan, Muhammad Asim
AU - Haroon, Nigil
AU - Borenstein, David
AU - Wang, Runsheng
AU - Biehl, Ann
AU - Fang, Meika A.
AU - Louie, Grant
AU - Majithia, Vikas
AU - Ng, Bernard
AU - Bigham, Rosemary
AU - Pianin, Michael
AU - Shah, Amit Aakash
AU - Sullivan, Nancy
AU - Turgunbaev, Marat
AU - Oristaglio, Jeff
AU - Turner, Amy
AU - Maksymowych, Walter P.
AU - Caplan, Liron
N1 - Funding Information:
We thank Cassie Shafer and Elin Aslanyan of the SAA for their partnership on this project. We thank SPARTAN for its partnership on this project. We thank our patient representatives for adding valuable perspectives. We thank the ACR staff, including Ms Regina Parker for assistance in organizing the face-to-face meeting and coordinating the administrative aspects of the project, and Ms Robin Lane for assistance in manuscript preparation. We thank Ms Janet Waters for help in developing the literature search strategy and performing the literature search and updates, and Ms Janet Joyce for peer-reviewing the literature search strategy.
Publisher Copyright:
© 2019, American College of Rheumatology. This article has been contributed to by US Government employees and their work is in the public domain in the USA.
PY - 2019/10/1
Y1 - 2019/10/1
N2 - Objective: To update evidence-based recommendations for the treatment of patients with ankylosing spondylitis (AS) and nonradiographic axial spondyloarthritis (SpA). Methods: We conducted updated systematic literature reviews for 20 clinical questions on pharmacologic treatment addressed in the 2015 guidelines, and for 26 new questions on pharmacologic treatment, treat-to-target strategy, and use of imaging. New questions addressed the use of secukinumab, ixekizumab, tofacitinib, tumor necrosis factor inhibitor (TNFi) biosimilars, and biologic tapering/discontinuation, among others. We used the Grading of Recommendations, Assessment, Development and Evaluation methodology to assess the quality of evidence and formulate recommendations and required at least 70% agreement among the voting panel. Results: Recommendations for AS and nonradiographic axial SpA are similar. TNFi are recommended over secukinumab or ixekizumab as the first biologic to be used. Secukinumab or ixekizumab is recommended over the use of a second TNFi in patients with primary nonresponse to the first TNFi. TNFi, secukinumab, and ixekizumab are favored over tofacitinib. Co-administration of low-dose methotrexate with TNFi is not recommended, nor is a strict treat-to-target strategy or discontinuation or tapering of biologics in patients with stable disease. Sulfasalazine is recommended only for persistent peripheral arthritis when TNFi are contraindicated. For patients with unclear disease activity, spine or pelvis magnetic resonance imaging could aid assessment. Routine monitoring of radiographic changes with serial spine radiographs is not recommended. Conclusion: These recommendations provide updated guidance regarding use of new medications and imaging of the axial skeleton in the management of AS and nonradiographic axial SpA.
AB - Objective: To update evidence-based recommendations for the treatment of patients with ankylosing spondylitis (AS) and nonradiographic axial spondyloarthritis (SpA). Methods: We conducted updated systematic literature reviews for 20 clinical questions on pharmacologic treatment addressed in the 2015 guidelines, and for 26 new questions on pharmacologic treatment, treat-to-target strategy, and use of imaging. New questions addressed the use of secukinumab, ixekizumab, tofacitinib, tumor necrosis factor inhibitor (TNFi) biosimilars, and biologic tapering/discontinuation, among others. We used the Grading of Recommendations, Assessment, Development and Evaluation methodology to assess the quality of evidence and formulate recommendations and required at least 70% agreement among the voting panel. Results: Recommendations for AS and nonradiographic axial SpA are similar. TNFi are recommended over secukinumab or ixekizumab as the first biologic to be used. Secukinumab or ixekizumab is recommended over the use of a second TNFi in patients with primary nonresponse to the first TNFi. TNFi, secukinumab, and ixekizumab are favored over tofacitinib. Co-administration of low-dose methotrexate with TNFi is not recommended, nor is a strict treat-to-target strategy or discontinuation or tapering of biologics in patients with stable disease. Sulfasalazine is recommended only for persistent peripheral arthritis when TNFi are contraindicated. For patients with unclear disease activity, spine or pelvis magnetic resonance imaging could aid assessment. Routine monitoring of radiographic changes with serial spine radiographs is not recommended. Conclusion: These recommendations provide updated guidance regarding use of new medications and imaging of the axial skeleton in the management of AS and nonradiographic axial SpA.
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U2 - 10.1002/acr.24025
DO - 10.1002/acr.24025
M3 - Article
C2 - 31436026
AN - SCOPUS:85071044679
SN - 2151-464X
VL - 71
SP - 1285
EP - 1299
JO - Arthritis Care and Research
JF - Arthritis Care and Research
IS - 10
ER -