ARP Rheumatology
ARP Rheumatology

Clinical Practice

ARP Rheumatology Jul/Set 2017 2017; (3) 209-218
Clinical practice, rules or action protocols

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


Machado P, Cerqueira M, Ávila-Ribeiro P, Aguiar R, Bernardo A, Sepriano A, Águeda A, Cordeiro A, Raposo A, Rodrigues A, Barcelos A, Malcata A, Lopes C, Vaz CC, Nour D, Godinho F, Alvarenga F, Pimentel-Santos F, Canhão H, Santos H, Cunha I, Neves J, Fonseca J, Gomes J, Tavares-Costa J, Costa L, Cunha-Miranda L, Maurício L, Cruz M, Afonso M, Santos M, Bernardes M, Valente P, Figueira R, Pimenta S, Ramiro S, Pedrosa T, Costa T, Vieira-Sousa E


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 literature evidence and consensus opinion. At a national meeting, the 7 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, seven 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 general 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 disease (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 inadequate response (where switching is recommended) or in the presence of long-term remission (where a process of biological therapy optimization can be considered, either a gradual increase in the interval between doses or a decrease of each dose of the biological therapy). Conclusion: These recommendations may be used for guidance in deciding which patients with axSpA should be treated with biological therapies. They cover 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.







Pedro Machado, Marcos Cerqueira, Pedro Ávila-Ribeiro, Renata Aguiar, Alexandra Bernardo, Alexandre Sepriano, Ana Águeda, Ana Cordeiro, Ana Raposo, Ana Rodrigues, Anabela Barcelos, Armando Malcata, Carina Lopes, Vaz CC, Dolores Nour, Fátima Godinho, Fernando Alvarenga, Fernando Pimentel-Santos, Helena Canhão, Helena Santos, Inês Cunha, Joana Neves, João Fonseca, João Gomes, José Tavares-Costa, Lúcia Costa, Luís Cunha-Miranda, Luís Maurício, Margarida Cruz, Maria Afonso, Maria Santos, Miguel Bernardes, Paula Valente, Ricardo Figueira, Sofia Pimenta, Sofia Ramiro, Teresa Pedrosa, Tiago Costa, Elsa Vieira-Sousa. Portuguese recommendations for the use of biological therapies in patients with axial spondyloarthritis – 2016 update. ARP, nº3, Jul/Set 2017:209-218. PMID: 28894079
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