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.
Anti-Inflammatory Agents, Non-Steroidal
/ therapeutic use
Antibodies, Monoclonal, Humanized
/ therapeutic use
Antirheumatic Agents
/ therapeutic use
Biological Products
/ therapeutic use
Biosimilar Pharmaceuticals
/ therapeutic use
Deprescriptions
Humans
Magnetic Resonance Imaging
Piperidines
/ therapeutic use
Protein Kinase Inhibitors
/ therapeutic use
Pyrimidines
/ therapeutic use
Pyrroles
/ therapeutic use
Radiography
Societies, Medical
Spondylarthropathies
/ diagnostic imaging
Spondylitis, Ankylosing
/ diagnostic imaging
Tumor Necrosis Factor Inhibitors
/ therapeutic use
Journal
Arthritis & rheumatology (Hoboken, N.J.)
ISSN: 2326-5205
Titre abrégé: Arthritis Rheumatol
Pays: United States
ID NLM: 101623795
Informations de publication
Date de publication:
10 2019
10 2019
Historique:
received:
28
03
2019
accepted:
09
07
2019
pubmed:
23
8
2019
medline:
25
2
2020
entrez:
23
8
2019
Statut:
ppublish
Résumé
To update evidence-based recommendations for the treatment of patients with ankylosing spondylitis (AS) and nonradiographic axial spondyloarthritis (SpA). 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. 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. 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.
Identifiants
pubmed: 31436036
doi: 10.1002/art.41042
pmc: PMC6764882
mid: NIHMS1042290
doi:
Substances chimiques
Anti-Inflammatory Agents, Non-Steroidal
0
Antibodies, Monoclonal, Humanized
0
Antirheumatic Agents
0
Biological Products
0
Biosimilar Pharmaceuticals
0
Piperidines
0
Protein Kinase Inhibitors
0
Pyrimidines
0
Pyrroles
0
Tumor Necrosis Factor Inhibitors
0
tofacitinib
87LA6FU830
ixekizumab
BTY153760O
secukinumab
DLG4EML025
Types de publication
Journal Article
Practice Guideline
Research Support, N.I.H., Intramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1599-1613Subventions
Organisme : Intramural NIH HHS
ID : Z01 AR041153-04
Pays : United States
Organisme : Spondylitis Association of America
Pays : International
Organisme : American College of Rheumatology
Pays : International
Organisme : Spondyloarthritis Research and Treatment Network
Pays : International
Commentaires et corrections
Type : CommentIn
Informations de 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.
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