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

Michael M. Ward, Atulya (Atul) Deodhar, Lianne S. Gensler, Maureen Dubreuil, David Yu, Muhammad Asim Khan, Nigil Haroon, David Borenstein, Runsheng Wang, Ann Biehl, Meika A. Fang, Grant Louie, Vikas Majithia, Bernard Ng, Rosemary Bigham, Michael Pianin, Amit Aakash Shah, Nancy Sullivan, Marat Turgunbaev, Jeff Oristaglio & 3 others Amy Turner, Walter P. Maksymowych, Liron Caplan

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
JournalArthritis Care and Research
DOIs
StateAccepted/In press - Jan 1 2019

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Spondylitis
LY2439821
Ankylosing Spondylitis
Tumor Necrosis Factor-alpha
Research
Biosimilar Pharmaceuticals
Therapeutics
Spine
Sulfasalazine
Politics
Biological Products
Pelvis
Skeleton
Methotrexate
Arthritis
Magnetic Resonance Imaging
Guidelines
secukinumab

ASJC Scopus subject areas

  • Rheumatology

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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. / Ward, Michael M.; Deodhar, Atulya (Atul); Gensler, Lianne S.; Dubreuil, Maureen; Yu, David; Khan, Muhammad Asim; Haroon, Nigil; Borenstein, David; Wang, Runsheng; Biehl, Ann; Fang, Meika A.; Louie, Grant; Majithia, Vikas; Ng, Bernard; Bigham, Rosemary; Pianin, Michael; Shah, Amit Aakash; Sullivan, Nancy; Turgunbaev, Marat; Oristaglio, Jeff; Turner, Amy; Maksymowych, Walter P.; Caplan, Liron.

In: Arthritis Care and Research, 01.01.2019.

Research output: Contribution to journalArticle

Ward, MM, Deodhar, AA, Gensler, LS, Dubreuil, M, Yu, D, Khan, MA, Haroon, N, Borenstein, D, Wang, R, Biehl, A, Fang, MA, Louie, G, Majithia, V, Ng, B, Bigham, R, Pianin, M, Shah, AA, Sullivan, N, Turgunbaev, M, Oristaglio, J, Turner, A, Maksymowych, WP & Caplan, L 2019, '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', Arthritis Care and Research. https://doi.org/10.1002/acr.24025
Ward, Michael M. ; Deodhar, Atulya (Atul) ; Gensler, Lianne S. ; Dubreuil, Maureen ; Yu, David ; Khan, Muhammad Asim ; Haroon, Nigil ; Borenstein, David ; Wang, Runsheng ; Biehl, Ann ; Fang, Meika A. ; Louie, Grant ; Majithia, Vikas ; Ng, Bernard ; Bigham, Rosemary ; Pianin, Michael ; Shah, Amit Aakash ; Sullivan, Nancy ; Turgunbaev, Marat ; Oristaglio, Jeff ; Turner, Amy ; Maksymowych, Walter P. ; Caplan, Liron. / 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. In: Arthritis Care and Research. 2019.
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abstract = "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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AU - Ward, Michael M.

AU - Deodhar, Atulya (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

PY - 2019/1/1

Y1 - 2019/1/1

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.

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