Portuguese recommendations for the use of biological therapies in patients with axial spondyloarthritis - 2016 update

• Autor(a) principal: Machado, P. M.
• Data de Publicação: 2018
• Outros Autores: Cerqueira, M., Ávila-Ribeiro, P., Aguiar, R., Bernardo, A., Sepriano, Alexandre, Águeda, A., Cordeiro, A., Raposo, A., Maria Rodrigues, Ana, Barcelos, A., Malcata, A., Lopes, C., Vaz, C. C., Nour, D., Godinho, F., Alvarenga, F., 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., on behalf of the Portuguese Society of Rheumatology
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://www.scopus.com/inward/record.url?scp=85042560361&partnerID=8YFLogxK
• topic: Ankylo - sing spondylitis; Axial spondyloarthritis; Biological therapies; Guidelines; Portugal; Re - commendations; Rheumatology

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.